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
3,500
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 new ideas into real
world care.
Join top decision makers in the room April
13 through the sixteenth.
For the agenda and event details, visit beckershospitalreview.com
and click on the events tab in the
upper right.
Hello, everyone, and welcome back to the Becker's
Healthcare podcast. I'm Mackenzie Bean, associate vice president
and managing editor of Becker's Hospital Review.
Today, I'm so thrilled to welcome back doctor
Geraldo
Xavier, who is a regional chief medical officer
with Atlantic Health System.
Doctor Xavier, welcome back to the podcast. Thanks
for joining us today.
Hey. Thanks, Mackenzie. Really appreciate you having me
on.
Hope all is well with you as well.
Looking forward to our conversation.
Yeah. I know we,
got to speak on the podcast
last spring. So here we are a year
later. So I'm excited to check-in and and
hear about some of the progress that you've
made and the efforts going on at Atlantic
Health System right now.
But I'm doing well. Thank you for asking.
Before we dive into the conversation, I'd love
to turn the floor over to you just
to briefly introduce yourself,
and tell us a little bit more about
your work at Atlantic Health System for anyone
who may not have caught your previous episode.
Sure. Absolutely.
Absolutely. So as you said, I'm a board
certified emergency medicine physician
and healthcare executive, currently serving as a regional
chief medical officer,
for Atlantic Health Hackettstown
and Newton Medical Centers. We are based in
New Jersey.
I've spent my career, leading large complex hospital
system,
through clinical, operational, and strategic transformation,
but always with a focus on quality patient
safety and health equity.
So a little bit about me. My background
combines both frontline clinical experience and executive leadership.
I began my career in emergency medicine and
progressively took
on additional leadership roles from medical director and
chair to,
chief quality officer to now my new, role
as the chief medical officer.
Those experiences have certainly helped shape my commitment
to serve in diverse and vulnerable populations while
driving measurable
system level improvements.
At Atlantic Health, I oversee clinical strategy and
operations for new in at Hackettstown Medical Centers,
two of our community,
medical centers within our network.
My responsibility,
while varied, includes
quality and patient safety,
regulatory
readiness,
clinical outcomes,
physician engagement, and care coordination.
I really work, it's a matrix organization, and
we work closely with our site based and
system leadership
as well as both employed and voluntary physician
to align with strategy and performance.
Really, with the key to ensure that we're
delivering high quality,
high reliable, strong value based care outcomes
with exceptional,
patient experience.
Yeah. Over my career, you have led,
significant challenges and work with transforming organization
to improve
their quality and reputation programs.
As we mentioned in the last
podcast, one of the work we did is
really focusing on how we improve readmissions
for these vulnerable cohorts,
pulmonary,
congestive heart failure, COPD, and acute myocardial infarction.
And that program has sustained some while undergoing
some challenges, has really sustained good improvements over
time,
really, which is something we're proud of.
Also,
really
looking forward to ensuring that we are,
continue to be a leapfrog aid at our
centers.
We do see hospital acquired conditions.
And really for me, really guiding emergency management
responses,
while what we did during the pandemic and
actually really post pandemic, really trying to strengthen
interdisciplinary
collaboration,
improve organizational
key performance indicators.
It really advanced for me personally working with
physician to advance
peer review transparency
and enhancing both workforce engagement and satisfaction.
So really,
I believe sustainable excellence in health care comes
from really aligning with physicians and aligning with
physicians and frontline teams
with executive leadership around a shared vision, delivering
safe, equitable, and high quality care for every
patient
every time.
So, really,
looking forward to this continued work that we're
doing within our health care space.
Yeah. I'm looking forward to hearing more about
it. I think you paint
such a clear strategic vision of this work
and and what needs to be done to
really move the needle for for
patients in your communities.
As you mentioned, the last time around the
podcast
laid out,
some information for us in terms of the
significant gains you've made in in readmissions, particularly
for those vulnerable groups.
I'm curious now speaking to you in early
twenty twenty six, as you reflect back on
the past twelve months, what would you say
is the most important initiative that you have
led? What did you do, and what were
some of the results that you've seen?
Yeah. Thanks.
As we said, so many different priorities, so
many things that are important to the organization
for many of the things you talk about.
But one of the, one of the important
initiative I'll share,
that I've
led and worked with the multidisciplinary
team over the past year is really
focusing on capacity management and patient flow,
specifically looking to reduce length of stay while
improving throughput, safety, and overall experience.
We are no different from many healthcare system.
We face rising volumes,
workforce constraints, and increasing
access challenges.
And, you know, patient flow is a passion
project as well for me because it's not
just an operational issue. It is fundamentally
a patient safety and quality imperative.
As we know that delays in,
patient flow or delays in movement creates,
risk and is a dissatisfier,
for patients.
They do affect care transition. It affects staff
workload,
and ultimately the care experience.
So,
with that in mind, I organized and led
a multidisciplinary capacity management
and capacity management and patient flow committee.
We brought together stakeholders from across the continuum,
such as nurse leadership, physicians,
transport, bed management, ancillary services.
Really, the key was ensuring that everyone who
touches the patient journey
had both a voice and a shared accountability,
because I believe that flow is not owned
by one department or one entity. It really
is a system responsibility.
With that premise,
we really approach this work using a multimodal
strategy.
We optimize
observational level of care management
by enhancing collaboration
between physicians,
physician advisors, case management, to ensure we have
the appropriate status designation
early in the hospitalization.
We partner with our clinical leaders to safely
shift appropriate
diagnostic testing from inpatient to outpatient setting.
This required
really meaningful
physician,
engagement and patient education,
but it significantly reduced avoidable inpatient days without
compromising quality.
As a result, we were able to reduce
our observation length of stay from an average
of thirty six to forty eight hours to
less than thirty hours and have been able
to sustain those gains.
That improvement alone created earlier, bed availability for
patients requiring inpatient level of care and significantly
improved our overall,
throughput efficiency.
One of the other key measures we took
on in this approach, in this multimodal
strategy is redesigning
daily interdisciplinary
bedside rounds
to improve real time communication
and identify discharge barriers early.
This helps us to align with the care
team around a clear daily plan and reduce
communication breakdown.
And I think more importantly, it helps us
to identify discharge barriers early, whether that be
clinical or logistical such as transportation needs so
we can address them more proactively
than reactively.
That focus on daily goals and expected discharge
dates
directly reduces length of stay and improves throughput.
It also supports discharge before noon and some
other key performance indicators and ensure beds available,
when patient needs it for the inpatient level
of care.
Equally, though, it does strengthen team engagement. Everyone
understands their role,
their shared accountability,
and everyone's working from the same plan.
And really when done right, interdisciplinary,
we call IDR rounds, can shift culture from
the fragmented care to really coordinated
high reliable care that benefits all, including patient
and staff.
And finally,
you know, we talked
about the way I really believe in robust
process improvement in our last episode. And this
is no different in this project where really
we use lean methodology
to help us streamline direct bedding from the
emergency department.
We started by just mapping out the process
to really understand where the delays in the
handoffs and rework occur.
And then we standardize that work,
therefore reducing unnecessary variation and then eliminating steps
that don't add value. The use of lean
help us to decrease the variation in workflow
between providers,
both ED providers and hospitalists
that that previously led to delays and redundant
handoff.
By standardizing the direct communication between those teams,
that helps to eliminate the non value added
steps and remove barriers to timely bed assignment.
We and this also helps us improve transparency
around throughput metrics and significantly reduce admission to
bedtime.
So this process really helped the team to
empower their frontline teams
to solve problems and shift the culture, again,
from just a reactive
firefighting to disciplined continuous improvement.
Overall, we achieved a measurable reduction in length
of stay from our baseline.
We improved admission to bedtime.
We shortened observation stays, as I mentioned,
to thirty hours and under,
and we improved some other KPIs such as
discharge before noon.
And that translated to really improve access and
decrease in ED boarding,
improving our financial performance, and higher patient and
staff satisfaction.
But I must say, from my perspective,
it really is not just about the metrics.
It really is about shifting the culture,
moving from reactive crisis management to proactive
capacity planning.
We really built a high functioning multidisciplinary
structure
that continues to drive improvement and resiliency across
the organization.
So that culture share from
creating a shared ownership of flow across the
different
multidisciplinary
teams that I mentioned
is what we know will sustain the results
long term.
So this is really exciting work that continues
a day to day, but it's really nice
to see how that structured approach
has allowed the teams to be empowered to
continue to ensure
that their processes are followed. And whenever there
is
opportunities where we may shift or,
there might be,
some, what I call,
metrics that may be not performing well is
to really look at it through the lens
of structural problem solving to say, what's not
working? How do we get back on board?
What do we need to do to engage?
What is it that we're learning from the
teams and do we need to pivot or
or any of those? So pretty exciting work
that, we continue to do.
Very exciting work with some significant
results, as you said.
And I I so appreciate your note about
the
the descriptive
structure being important, but also
the the culture really underpinning everything, as you
said, patient journey,
needing to be everyone's accountability.
I think that's such a key part of
it.
I'm curious now looking ahead and say over
the next,
you know, ten months of 2026,
what would you say are your biggest priorities
and headwinds that you're focused on now?
Yeah. Great question.
It feels like we just came out from
the,
these respiratory surges that we see across the
country. But,
really, looking ahead, our focus is centered on
events in our organizational
key strategic priorities,
while navigating some of these real headwinds in
health care.
A couple I, you know, a couple priorities
are is, you know, one is definitely our
clinical excellence.
It remains our foundational,
priority.
We are continuing to strengthen our, high reliability
practice, reduce preventable harm, and really leverage data
to drive consistent evidence based care across all
service lines.
I will be remiss to say one of
the one of the most important,
factors as well is really improving our consumer
experience.
Patient expect access, transparency, and seamless coordination.
So we're really working to simplify the care
journey,
while expanding digital capabilities and improving communication.
You know, leveraging workforce experience,
or and and elevating workforce experience is also
a top priority.
I mean, I'm sure in talking to other
leaders across the country as you do through
this,
podcast and other avenues of communicating with healthcare
leaders, I'm sure you hear about workforce fatigue,
recruitment pressures, and retention challenges.
And there remain headwinds across the industry.
We are focused on engagement,
leadership development, and create an environment where our
team members feel supported and heard and empowered
to do their best work.
And, again,
financial stewardship underpins everything
with ongoing reimbursement
pressures and rising costs. You know, we have
to stay disciplined. We have to use data
to drive
decisions
and operationally stay efficient
while continuing to invest strategically in quality and
innovation.
So, while, like I said, the headwinds are
definitely our workforce constraint,
regulatory complexity, and margin compression,
which are real. I believe, organizations
that stay anchored in quality, equity, and strong
physician alignment,
really is best positioned to, withstand 2026,
and to thrive beyond that.
Mhmm.
That focus is really core to everything. Right?
Yeah.
As you said, there are a variety
of headwinds that, not just you, but health
system executives across the country are facing right
now, obviously.
Acknowledging those, what do you think specifically is
gonna be the hardest thing that you have
to do over the coming year?
That's a great question, Mackenzie.
I think the hardest thing, in the coming
year will be balancing those financial discipline
with our commitment to clinical excellence and workforce
engagement.
As I said, we can healthcare continues to
face margin pressures,
reimbursement uncertainty, and rise in labor and supply
costs.
But at the same time, we're responsible
for our patients and our teams are having
changed. In fact, the expectations
are even higher than ever.
And so, the challenge is making thoughtful,
data driven decision about resource allocation
without compromising
safety and quality or or access, especially
if you're in community hospitals.
Access can definitely be sometimes a challenge.
Another difficult aspect,
in the coming year is leading through continued
workforce fatigue.
I know that several of my colleagues
within emergency medicine field, as well as in
leadership, have pivoted away from some of that
to other less grueling,
opportunities
due to, just fatigue.
Even as we move toward from the acute
phase of the pandemic,
I think we still see the emotional and
operational
toll,
that remains.
So supporting our teams
while also making sure
that they can adapt to change,
improve efficiency, and embrace innovation,
will require a different type of leadership that
includes
empathy,
transparency
and steadfast leadership.
So I think the ultimately,
you know, the hardest part is making sure
that we make these tough decisions,
but in a way that maintains trust trust
and trust with our frontline team, with our
physicians
teams,
with our nursing team and our community.
That means that we really have to have
really great communication,
shared accountability,
and really staying anchored in our mission.
And I think if we can do these
things,
while very difficult,
that will create opportunities to strengthen the organization.
Absolutely.
Doctor Xavier, I I'm always just,
so impressed that, you know, your your focused
approach, your dedication to quality and clinical excellence,
and it really shines through in in your
remarks today. So thank you so much for
rejoining us on the podcast to give us
a glance into some of your priorities and
focuses right now. We so appreciate it. Is
there anything else you'd like to add or
end on?
No. I think, again, thank you so much
for the opportunity for the conversation.
I really appreciate and enjoy,
you know, these these chats. I think that
as leaders, we are all trying to really
be supportive
and make sure that we are able to
provide what's needed for team members
in a really, in an environment that is
psychologically
safe, that empowers them to be their best,
that empowers them to work at the top
of their license.
And, you know, and, and making
the environment a great place to work. And
I think we, Atlantic Health System, as an
organization, have always prioritized
being a place that our team members can
find a great place to work because we
do provide some of these,
not just,
the ability to feel safe and to, have
joined in work, but also focusing really on,
succession building, workforce development engagement,
leadership support, and really providing the infrastructure
so that they can do their best work
and work, at the top of their license.
So,
you know, at this juncture where we are,
it really is
really enlightening to continue to journey,
with an organization that has such a great
priority on its workforce. So thank you so
much once again.
Hope to see you
one of these good days as,
Yes. I know.
We're excited to conferences.
Yes. We're excited to have you at our
annual meeting in April.
Looking forward to it. Wonderful. Well, thank you
again so much, doctor Xavier. And listeners, thank
you as well for tuning in. You can
find more podcast episodes by visiting the Becker's
podcast page at beckershospitalreview.com/podcasts.