1 00:00:01,520 --> 00:00:04,080 Every year, Becker's annual meeting brings health care 2 00:00:04,080 --> 00:00:06,559 leaders together to unpack the most pressing issues 3 00:00:06,559 --> 00:00:07,620 facing the industry. 4 00:00:08,000 --> 00:00:10,820 And every year, those conversations shift in profound 5 00:00:10,880 --> 00:00:12,179 and unexpected ways. 6 00:00:12,559 --> 00:00:14,880 This April, more than 3,500 7 00:00:14,880 --> 00:00:17,024 health care executives will return to Chicago 8 00:00:17,324 --> 00:00:19,265 for Becker's sixteenth annual meeting. 9 00:00:19,725 --> 00:00:21,005 795 10 00:00:21,005 --> 00:00:23,804 elite speakers will offer new lessons, new case 11 00:00:23,804 --> 00:00:26,385 studies, and predictions about what comes next. 12 00:00:26,685 --> 00:00:28,945 Join us April 13 through the sixteenth. 13 00:00:29,324 --> 00:00:33,770 For the agenda and event details, visit beckershospitalreview.com 14 00:00:33,770 --> 00:00:35,609 and click on the events tab in the 15 00:00:35,609 --> 00:00:36,429 upper right. 16 00:00:37,929 --> 00:00:40,250 This is Laura Dirda with the Becker's Healthcare 17 00:00:40,250 --> 00:00:42,409 podcast. I'm thrilled today to be joined by 18 00:00:42,409 --> 00:00:45,469 doctor Marley, chief medical officer at Geisinger Clinic. 19 00:00:45,844 --> 00:00:47,045 Doctor Marley, it's a pleasure to have you 20 00:00:47,045 --> 00:00:48,104 on the podcast today. 21 00:00:48,484 --> 00:00:50,884 Such a pleasure to be here, Laura. Absolutely. 22 00:00:50,884 --> 00:00:52,645 Now I'm excited for our conversation because I 23 00:00:52,645 --> 00:00:55,604 know Geisinger is such a innovative organization and 24 00:00:55,604 --> 00:00:56,265 and truly, 25 00:00:57,045 --> 00:00:58,564 an area where in health care, you know, 26 00:00:58,564 --> 00:01:00,984 there's so many opportunities to do things differently 27 00:01:01,479 --> 00:01:04,359 and use technology as well as transformational efforts. 28 00:01:04,359 --> 00:01:05,799 And so I'm excited to learn more about 29 00:01:05,799 --> 00:01:07,479 what you're doing at Geisinger. But before we 30 00:01:07,479 --> 00:01:09,560 do, can you introduce yourself and just tell 31 00:01:09,560 --> 00:01:11,420 us a little bit about the health system? 32 00:01:11,879 --> 00:01:12,379 Sure. 33 00:01:12,840 --> 00:01:14,459 So I am a nephrologist 34 00:01:14,760 --> 00:01:16,875 by trade and serve as the chief medical 35 00:01:16,875 --> 00:01:18,174 officer at Geisinger Clinic. 36 00:01:18,634 --> 00:01:21,674 And Geisinger as an organization is an integrated 37 00:01:21,674 --> 00:01:24,234 health system that has a very broad footprint 38 00:01:24,234 --> 00:01:25,134 across Pennsylvania. 39 00:01:25,834 --> 00:01:28,729 We serve some urban areas, but largely rural 40 00:01:28,729 --> 00:01:29,229 communities 41 00:01:29,769 --> 00:01:30,269 across 42 00:01:30,569 --> 00:01:31,069 Central, 43 00:01:31,849 --> 00:01:32,349 Pennsylvania. 44 00:01:33,049 --> 00:01:34,670 Today, we care for approximately 45 00:01:35,129 --> 00:01:36,590 1,200,000 46 00:01:36,649 --> 00:01:37,549 unique lives, 47 00:01:37,929 --> 00:01:40,094 across the clinical enterprise. And this would be 48 00:01:40,255 --> 00:01:42,575 the hospitals. It would be the ambulatory care, 49 00:01:42,575 --> 00:01:44,974 the post secured care, the home based services 50 00:01:44,974 --> 00:01:47,474 that we provide including our health plan. 51 00:01:48,174 --> 00:01:50,194 While that skill gives us opportunity 52 00:01:50,895 --> 00:01:51,954 and a responsibility, 53 00:01:53,375 --> 00:01:53,790 it 54 00:01:54,189 --> 00:01:56,189 lays out the need for us to design 55 00:01:56,189 --> 00:01:57,010 care models, 56 00:01:57,709 --> 00:01:59,329 that are clinically excellent, 57 00:02:00,030 --> 00:02:02,209 but also deeply patient centered 58 00:02:02,829 --> 00:02:06,109 with a great focus on zero harm and 59 00:02:06,109 --> 00:02:06,770 high reliability 60 00:02:07,390 --> 00:02:09,169 where safety is our core value. 61 00:02:09,655 --> 00:02:11,414 I hope that that provides you some sense 62 00:02:11,414 --> 00:02:13,034 of who we are as an organization. 63 00:02:14,294 --> 00:02:16,534 Oh, absolutely. And I I think, you know, 64 00:02:16,534 --> 00:02:19,094 having that ability to design those care models, 65 00:02:19,094 --> 00:02:21,334 think about clinical excellence, and then really define 66 00:02:21,334 --> 00:02:23,275 it as zero harm and high reliability, 67 00:02:24,159 --> 00:02:26,319 you know, is truly a huge goal and 68 00:02:26,319 --> 00:02:28,239 a huge undertaking. And so to see how 69 00:02:28,239 --> 00:02:28,739 successful 70 00:02:29,120 --> 00:02:31,439 that you've been at Geisinger, in achieving those 71 00:02:31,439 --> 00:02:34,259 things is is, really inspiring. 72 00:02:34,799 --> 00:02:36,254 Now I was wondering wondering if we could 73 00:02:36,254 --> 00:02:37,694 zero in on the last year or so. 74 00:02:38,014 --> 00:02:39,775 Could you tell us about the most important 75 00:02:39,775 --> 00:02:41,294 initiative that you led? What did you do, 76 00:02:41,294 --> 00:02:42,435 and what were the results? 77 00:02:43,134 --> 00:02:46,194 Yeah. So my my role is actually 78 00:02:46,814 --> 00:02:47,715 bringing physicians, 79 00:02:48,419 --> 00:02:48,919 clinicians, 80 00:02:49,620 --> 00:02:52,500 nursing, as well as operational teams altogether and 81 00:02:52,500 --> 00:02:53,959 greasing the skits. Right? 82 00:02:54,259 --> 00:02:56,099 There are several projects that we've been involved 83 00:02:56,099 --> 00:02:58,199 in, whether it is related to access, 84 00:02:58,500 --> 00:03:00,680 new patient access, whether it's care redesign, 85 00:03:01,379 --> 00:03:03,159 whether it's innovative care models, 86 00:03:03,939 --> 00:03:05,104 so on and so forth. 87 00:03:05,485 --> 00:03:08,205 But I think the most meaningful initiative for 88 00:03:08,205 --> 00:03:10,925 me this past year has been a system 89 00:03:10,925 --> 00:03:11,824 wide redesign 90 00:03:12,685 --> 00:03:15,504 of our approach to serious and advancing illness. 91 00:03:16,125 --> 00:03:17,185 The work is sorted 92 00:03:17,650 --> 00:03:20,870 on a very simple but uncomfortable truth. 93 00:03:21,409 --> 00:03:24,710 While everyone agrees that advanced care plan conversations 94 00:03:24,770 --> 00:03:25,510 are important, 95 00:03:26,290 --> 00:03:27,830 they often happen late, 96 00:03:28,610 --> 00:03:29,349 are inconsistent, 97 00:03:29,889 --> 00:03:31,510 or do not happen at all. 98 00:03:32,264 --> 00:03:34,824 Most people want to die at home surrounded 99 00:03:34,824 --> 00:03:36,444 by the comfort of their 100 00:03:36,905 --> 00:03:39,305 family as well as the familiarity of the 101 00:03:39,305 --> 00:03:40,844 home, and yet 102 00:03:41,145 --> 00:03:43,784 only a very small fraction of people actually 103 00:03:43,784 --> 00:03:44,284 do. 104 00:03:45,129 --> 00:03:47,050 This means more to me because I lost 105 00:03:47,050 --> 00:03:49,389 my mother this past year and my mother-in-law 106 00:03:49,610 --> 00:03:51,290 the year before, both of whom who died 107 00:03:51,290 --> 00:03:51,950 at home. 108 00:03:52,810 --> 00:03:54,909 For our seniors, that cost 109 00:03:55,210 --> 00:03:56,189 of that disconnect 110 00:03:56,569 --> 00:03:57,629 between their desires 111 00:03:58,010 --> 00:03:59,310 to what really happens 112 00:03:59,689 --> 00:04:00,104 is 113 00:04:00,504 --> 00:04:01,004 enormous. 114 00:04:01,705 --> 00:04:02,364 Too often, 115 00:04:02,905 --> 00:04:03,884 we as clinicians 116 00:04:04,344 --> 00:04:06,905 fail to involve patients and families early in 117 00:04:06,905 --> 00:04:08,125 a shared decision making, 118 00:04:08,584 --> 00:04:11,245 and these conversations are hard. They're not easy. 119 00:04:12,104 --> 00:04:14,664 They compete with many other clinical priorities in 120 00:04:14,664 --> 00:04:15,164 practice. 121 00:04:15,650 --> 00:04:17,270 And when they happen too late, 122 00:04:17,649 --> 00:04:19,889 patients are deprived of a chance to develop 123 00:04:19,889 --> 00:04:21,029 prognostic awareness 124 00:04:21,569 --> 00:04:23,910 to reflect on what truly matters to them 125 00:04:24,129 --> 00:04:26,149 and shape the care of 126 00:04:26,529 --> 00:04:27,430 the process 127 00:04:27,904 --> 00:04:30,785 as well as the support to preserve quality 128 00:04:30,785 --> 00:04:31,444 of life. 129 00:04:32,144 --> 00:04:34,944 So but when it's done well and when 130 00:04:34,944 --> 00:04:36,324 it is done early, 131 00:04:36,785 --> 00:04:38,805 those conversations change everything. 132 00:04:39,185 --> 00:04:40,324 They improve outcomes, 133 00:04:41,079 --> 00:04:43,419 related to disability, related to pain, 134 00:04:43,800 --> 00:04:47,579 treatment invasiveness. They address mood and psychological distress. 135 00:04:48,279 --> 00:04:50,519 And they also actually help families to see 136 00:04:50,519 --> 00:04:52,300 death as a non traumatic event, 137 00:04:52,600 --> 00:04:54,539 not as a failure and as a natural 138 00:04:54,600 --> 00:04:56,654 outcome of serious illness. 139 00:04:57,134 --> 00:04:58,915 And so importantly, it reduces 140 00:04:59,454 --> 00:05:02,975 unwanted in hospital deaths and very late referrals 141 00:05:02,975 --> 00:05:06,254 to hospice where patients can find comfort and 142 00:05:06,254 --> 00:05:07,714 improve quality of life. 143 00:05:08,254 --> 00:05:10,654 Yet there is a paradox. In our entire 144 00:05:10,654 --> 00:05:12,274 country, this paradox exists. 145 00:05:13,270 --> 00:05:15,770 Everyone knows that these conversations are important. 146 00:05:16,470 --> 00:05:19,610 And when everyone knows these conversations are important 147 00:05:19,670 --> 00:05:22,649 and it becomes everyone's job to address it, 148 00:05:22,709 --> 00:05:24,970 it becomes no one's job to do it. 149 00:05:25,334 --> 00:05:28,154 They go far beyond delivering bad news. Right? 150 00:05:28,214 --> 00:05:30,935 They translate directly into medical decisions. They require 151 00:05:30,935 --> 00:05:32,795 coordination across settings. 152 00:05:33,175 --> 00:05:36,475 And in the absence of clear medical guidelines, 153 00:05:37,175 --> 00:05:40,154 clinicians are left to balance between patient autonomy 154 00:05:40,480 --> 00:05:41,379 and non maleficience, 155 00:05:42,080 --> 00:05:45,040 something we do imperfectly and for that matter 156 00:05:45,040 --> 00:05:46,500 the whole country does imperfectly. 157 00:05:47,680 --> 00:05:49,600 So we started to establish a very clear 158 00:05:49,600 --> 00:05:50,100 baseline 159 00:05:50,480 --> 00:05:52,240 and I think it was important for us 160 00:05:52,240 --> 00:05:54,134 to know how effective we were, 161 00:05:54,855 --> 00:05:56,795 in terms of our advanced care planning 162 00:05:57,335 --> 00:05:58,875 with our senior bundles. 163 00:05:59,254 --> 00:06:01,895 And what our dashboard showed is that we 164 00:06:01,895 --> 00:06:03,514 haven't budged our numbers 165 00:06:03,975 --> 00:06:06,634 beyond five percent until a year ago. 166 00:06:07,069 --> 00:06:09,250 Those numbers made that very, very real. 167 00:06:10,029 --> 00:06:11,949 And so what we did is we looked 168 00:06:11,949 --> 00:06:13,410 at it clinically and operationally. 169 00:06:13,949 --> 00:06:15,490 We focused on care fragmentation. 170 00:06:15,949 --> 00:06:18,509 We focused on patient experience. We focused on 171 00:06:18,509 --> 00:06:21,389 end of life outcomes, and we completely redesigned 172 00:06:21,389 --> 00:06:22,689 the model end to end. 173 00:06:23,444 --> 00:06:25,144 At the core of this model, 174 00:06:25,845 --> 00:06:27,544 we have a very high touch, 175 00:06:28,004 --> 00:06:29,785 tightly integrated clinical model 176 00:06:30,324 --> 00:06:32,884 designed specifically to care for the sickest of 177 00:06:32,884 --> 00:06:33,544 our sick. 178 00:06:34,004 --> 00:06:36,485 We embedded a very focused team with very 179 00:06:36,485 --> 00:06:37,865 deep palliative expertise 180 00:06:38,980 --> 00:06:41,800 and clear clinical oversight to partner with patients 181 00:06:42,100 --> 00:06:43,879 who have a predicted life expectancy 182 00:06:44,420 --> 00:06:46,120 of twelve months or less 183 00:06:46,420 --> 00:06:48,759 using a validated predictive tool. 184 00:06:49,139 --> 00:06:51,480 The team works alongside with the patient 185 00:06:51,954 --> 00:06:54,754 and basically goes throughout the entire last mile 186 00:06:54,754 --> 00:06:55,574 of their journey. 187 00:06:55,875 --> 00:06:58,514 The role is not scripted at all. It 188 00:06:58,514 --> 00:07:01,735 is a series of conversations that happen longitudinally 189 00:07:02,595 --> 00:07:03,735 and help patients 190 00:07:04,279 --> 00:07:07,020 cope with their serious illness and the enormity 191 00:07:07,080 --> 00:07:09,819 of their illness through a continuum of conversations. 192 00:07:10,520 --> 00:07:13,580 These conversations are delivered reliably and consistently. 193 00:07:14,279 --> 00:07:16,199 And whether the patient's at home or in 194 00:07:16,199 --> 00:07:18,615 a post acute setting, it does not matter. 195 00:07:18,854 --> 00:07:21,354 This team actually focuses on that. 196 00:07:21,654 --> 00:07:24,454 And the intent is very simple. Right? Give 197 00:07:24,454 --> 00:07:26,555 patients and families time. 198 00:07:27,254 --> 00:07:29,435 Time to cognitively and emotionally 199 00:07:30,774 --> 00:07:33,435 understand and process the prognostic information. 200 00:07:34,639 --> 00:07:35,540 Time to oscillate 201 00:07:35,919 --> 00:07:36,419 naturally 202 00:07:36,959 --> 00:07:37,459 between 203 00:07:37,919 --> 00:07:40,579 hope and realism and type to adapt. 204 00:07:41,439 --> 00:07:43,439 So the work did not happen just like 205 00:07:43,439 --> 00:07:44,740 that. It took a village. 206 00:07:45,439 --> 00:07:48,000 In fact, it required our ethics teams to 207 00:07:48,000 --> 00:07:48,740 come together 208 00:07:49,105 --> 00:07:51,045 to review our tools, 209 00:07:51,585 --> 00:07:53,425 the College of Health Sciences from the standpoint 210 00:07:53,425 --> 00:07:54,725 of cascading education, 211 00:07:55,504 --> 00:07:56,004 multidisciplinary 212 00:07:56,464 --> 00:08:00,485 clinical teams, specialists in palliative care, the hospital 213 00:08:00,545 --> 00:08:01,925 partners, the nurses, 214 00:08:02,569 --> 00:08:05,069 and the nursing leaders all stacked hands 215 00:08:05,449 --> 00:08:07,930 recognizing both the urgency as well as the 216 00:08:07,930 --> 00:08:09,230 complexity of the work. 217 00:08:09,930 --> 00:08:10,829 Along the way, 218 00:08:11,290 --> 00:08:12,990 we confronted real challenges. 219 00:08:13,689 --> 00:08:16,589 Okay. It was difficult to actually cascade that 220 00:08:16,649 --> 00:08:17,149 education 221 00:08:18,254 --> 00:08:19,475 on dying with dignity 222 00:08:19,935 --> 00:08:21,954 because we had imperfect triggers. 223 00:08:22,574 --> 00:08:25,694 And the care was very, very fragmented between 224 00:08:25,694 --> 00:08:28,334 the inpatient, the outpatient, the post acute, as 225 00:08:28,334 --> 00:08:29,634 well as the home settings. 226 00:08:30,334 --> 00:08:32,434 So we also had to acknowledge that 227 00:08:33,200 --> 00:08:34,500 there was a hard truth. 228 00:08:35,120 --> 00:08:37,360 The truth was that we commonly used a 229 00:08:37,360 --> 00:08:40,480 surprise question, and the surprise question was asking 230 00:08:40,480 --> 00:08:41,779 our physicians and clinicians 231 00:08:42,480 --> 00:08:45,139 whether they would be surprised if this patient 232 00:08:45,200 --> 00:08:47,674 died in one year. And realized that that 233 00:08:47,674 --> 00:08:50,554 was a very imperfect signal when patients and 234 00:08:50,554 --> 00:08:51,455 family needed 235 00:08:51,835 --> 00:08:52,975 deeper support. 236 00:08:53,514 --> 00:08:55,674 So what we did is we pulled in 237 00:08:55,674 --> 00:08:57,375 our my care choices team. 238 00:08:57,995 --> 00:08:59,134 We helped explore 239 00:08:59,835 --> 00:09:01,695 the elements that really matter. 240 00:09:02,029 --> 00:09:04,129 We went through that process intentionally 241 00:09:04,910 --> 00:09:07,250 and then wanted to get to real change. 242 00:09:07,710 --> 00:09:10,750 This far, we've enrolled about 1,800 patients or 243 00:09:10,750 --> 00:09:13,309 so of the highest risk sickest of the 244 00:09:13,309 --> 00:09:14,129 six seniors. 245 00:09:14,884 --> 00:09:17,044 The book focused on exploring their hopes, their 246 00:09:17,044 --> 00:09:18,424 worries, their grievances, 247 00:09:19,205 --> 00:09:22,004 their clarity on priorities, as well as building 248 00:09:22,004 --> 00:09:24,485 coping skills to live with the serious illness 249 00:09:24,485 --> 00:09:26,725 at home. And as I said, this is 250 00:09:26,725 --> 00:09:28,485 not a single conversation. This is a very 251 00:09:28,485 --> 00:09:31,110 iterative process that unfolded over months. 252 00:09:31,649 --> 00:09:34,070 And as patients integrated that information, 253 00:09:34,690 --> 00:09:37,269 they understood the trajectory of their illness 254 00:09:37,809 --> 00:09:40,529 and started to focus on what matters most 255 00:09:40,529 --> 00:09:41,190 to them. 256 00:09:42,144 --> 00:09:44,865 Those things translated to clear goals and values 257 00:09:44,865 --> 00:09:47,345 of shared decision making for them as well 258 00:09:47,345 --> 00:09:49,825 as our teams. This was a huge cultural 259 00:09:49,825 --> 00:09:52,544 chip. So we started with about a five 260 00:09:52,544 --> 00:09:53,924 percent bundle rate, 261 00:09:54,320 --> 00:09:56,320 and now we are holding at about forty 262 00:09:56,320 --> 00:10:00,019 five to 50% of our identified patients completely 263 00:10:00,159 --> 00:10:01,379 engaged in the process. 264 00:10:02,000 --> 00:10:02,500 And 265 00:10:03,279 --> 00:10:04,740 in the recent snapshot 266 00:10:05,279 --> 00:10:08,159 of the thousand or so patients who had 267 00:10:08,159 --> 00:10:09,460 been completely engaged, 268 00:10:09,934 --> 00:10:12,975 we recognized that close to about a third 269 00:10:12,975 --> 00:10:15,154 of them had celestial ascent. 270 00:10:15,615 --> 00:10:18,495 And of the third, 50% of them spend 271 00:10:18,495 --> 00:10:21,134 their time in hospice with an average hospice 272 00:10:21,134 --> 00:10:24,350 time of approximately thirty days. So a significant 273 00:10:24,570 --> 00:10:26,490 shift from where we were. And this to 274 00:10:26,490 --> 00:10:28,509 me was the most meaningful initiative 275 00:10:28,889 --> 00:10:30,990 that we've had from my perspective. 276 00:10:31,850 --> 00:10:33,370 I I know this was a very long 277 00:10:33,370 --> 00:10:35,289 response, Laura, but I thought it's important to 278 00:10:35,289 --> 00:10:36,990 lay out the the elements. 279 00:10:38,245 --> 00:10:40,884 Yeah. Absolutely. No. That was fantastic. And I 280 00:10:40,884 --> 00:10:43,444 really appreciate you going into detail about how 281 00:10:43,444 --> 00:10:45,204 you put this together and and why it 282 00:10:45,204 --> 00:10:46,584 was so important and critical, 283 00:10:47,125 --> 00:10:49,384 because I think it's something that, you know, 284 00:10:49,605 --> 00:10:49,924 many, 285 00:10:50,509 --> 00:10:53,490 hospitals and systems overlook or or just continue 286 00:10:53,549 --> 00:10:55,789 to handle this patient population in the way 287 00:10:55,789 --> 00:10:57,789 they always did, which is high cost and 288 00:10:57,789 --> 00:10:59,870 not exactly, as you mentioned, you know, what 289 00:10:59,870 --> 00:11:01,549 the patients or families want, 290 00:11:01,950 --> 00:11:03,549 in the experience for the the end of 291 00:11:03,549 --> 00:11:05,304 their life. And so I know it's so 292 00:11:05,304 --> 00:11:07,865 critical having these conversations and putting these systems 293 00:11:07,865 --> 00:11:10,584 together. And, you know, I I appreciate you 294 00:11:10,584 --> 00:11:13,065 also mentioning all the the number of folks 295 00:11:13,065 --> 00:11:15,625 that are involved in, putting this together, whether 296 00:11:15,625 --> 00:11:16,524 it's the clinical 297 00:11:17,029 --> 00:11:19,029 leaders as well as the ethics teams and 298 00:11:19,029 --> 00:11:21,029 and everybody else just to make sure it's 299 00:11:21,029 --> 00:11:22,629 done in the right way, in a meaningful 300 00:11:22,629 --> 00:11:24,090 and a compassionate way too, 301 00:11:24,550 --> 00:11:25,370 because it's 302 00:11:25,830 --> 00:11:27,830 a a a very challenging time. I know 303 00:11:27,830 --> 00:11:30,070 in the patients and live lives of their 304 00:11:30,070 --> 00:11:31,544 family members too. And so, 305 00:11:32,105 --> 00:11:34,345 it makes a big difference. Now when you 306 00:11:34,345 --> 00:11:36,345 think about the future, where do you see 307 00:11:36,345 --> 00:11:38,264 the, system heading? What are some of the 308 00:11:38,264 --> 00:11:39,865 big priorities and headwinds that you have your 309 00:11:39,865 --> 00:11:41,325 eye on for 2026? 310 00:11:41,784 --> 00:11:44,184 Oh, there are several. But but I think 311 00:11:44,184 --> 00:11:45,725 I think when I think about it, 312 00:11:46,200 --> 00:11:48,300 perhaps the most important piece 313 00:11:48,679 --> 00:11:49,820 for us to scale 314 00:11:50,679 --> 00:11:52,379 what we need to do as an organization 315 00:11:53,160 --> 00:11:55,340 is the physician APP alignment. 316 00:11:55,720 --> 00:11:56,220 Right? 317 00:11:56,920 --> 00:11:58,620 I think the care team realignment 318 00:11:59,495 --> 00:12:01,575 and having the teams practice at the top 319 00:12:01,575 --> 00:12:03,334 of our license is a refrain that we've 320 00:12:03,334 --> 00:12:05,595 heard for a long time. But in reality, 321 00:12:05,654 --> 00:12:08,455 that alignment and engagement is probably one of 322 00:12:08,455 --> 00:12:09,674 our biggest opportunities. 323 00:12:10,934 --> 00:12:13,334 The other pieces that come along with that 324 00:12:13,334 --> 00:12:14,634 is workforce sustainability. 325 00:12:16,110 --> 00:12:18,350 Trying to use data or, you know, what 326 00:12:18,350 --> 00:12:20,529 is right now the buzzword AI, 327 00:12:21,550 --> 00:12:23,170 in terms of services. 328 00:12:24,430 --> 00:12:25,250 Access redesign, 329 00:12:25,870 --> 00:12:26,930 which is again 330 00:12:27,389 --> 00:12:29,835 a bread and butter element, but looking to 331 00:12:29,835 --> 00:12:32,654 figure out how we can actually improve access 332 00:12:33,195 --> 00:12:36,095 for our new patients and more importantly, 333 00:12:36,955 --> 00:12:39,514 continuity of care that is not episodic or 334 00:12:39,514 --> 00:12:40,014 fractured 335 00:12:40,394 --> 00:12:41,774 is is another element. 336 00:12:42,809 --> 00:12:45,289 We have other areas that we are working 337 00:12:45,289 --> 00:12:46,350 on as big ticket, 338 00:12:46,730 --> 00:12:47,230 issues 339 00:12:47,690 --> 00:12:49,149 related to clinical pathways, 340 00:12:50,089 --> 00:12:51,709 having a pharmacy led management, 341 00:12:52,089 --> 00:12:54,190 and then focusing on patient experience, 342 00:12:54,649 --> 00:12:57,745 particularly as it relates to their likelihood to 343 00:12:57,745 --> 00:12:59,845 recommend as the primary signal 344 00:13:00,225 --> 00:13:02,785 that we follow from the standpoint of care. 345 00:13:02,785 --> 00:13:05,665 Now none of these topics that I'm sharing 346 00:13:05,665 --> 00:13:08,225 with you are new topics. These are topics 347 00:13:08,225 --> 00:13:08,965 that have 348 00:13:09,830 --> 00:13:12,070 been things that we are working, but we 349 00:13:12,070 --> 00:13:15,610 are reengineering these all and again to address 350 00:13:15,750 --> 00:13:16,970 what needs to be done. 351 00:13:17,509 --> 00:13:20,070 Now in terms of your question related to 352 00:13:20,070 --> 00:13:20,570 headwinds, 353 00:13:21,350 --> 00:13:22,649 I think the 354 00:13:23,575 --> 00:13:24,394 biggest headwinds 355 00:13:25,334 --> 00:13:28,855 are workforce constraints. Right? The changing mix in 356 00:13:28,855 --> 00:13:30,554 terms of physicians versus, 357 00:13:31,095 --> 00:13:32,554 APPs or clinicians, 358 00:13:33,334 --> 00:13:36,134 and then clinician fatigue. Because now you have 359 00:13:36,134 --> 00:13:38,794 sicker, older patients in the hospital setting, 360 00:13:39,309 --> 00:13:41,629 particularly in a rural environment where there are 361 00:13:41,629 --> 00:13:45,710 also financial challenges and challenges of social determinants 362 00:13:45,710 --> 00:13:46,370 of health, 363 00:13:47,070 --> 00:13:48,290 that is substantial. 364 00:13:49,309 --> 00:13:49,809 That 365 00:13:50,509 --> 00:13:51,490 is in 366 00:13:51,855 --> 00:13:54,254 further it is kind of tied in with 367 00:13:54,254 --> 00:13:57,695 the financial pressures of the decisions that are 368 00:13:57,695 --> 00:14:00,095 coming down the federal as well as the 369 00:14:00,095 --> 00:14:00,595 state, 370 00:14:01,134 --> 00:14:02,355 related regulations 371 00:14:02,975 --> 00:14:05,475 and support from the standpoint of health care. 372 00:14:05,855 --> 00:14:07,230 And then aligning 373 00:14:07,529 --> 00:14:08,509 what is required 374 00:14:09,210 --> 00:14:11,049 from the standpoint of clinical care with the 375 00:14:11,049 --> 00:14:11,549 patient, 376 00:14:11,929 --> 00:14:13,549 and what the patients actually want. 377 00:14:13,850 --> 00:14:15,450 So so those, I think, are the big 378 00:14:15,450 --> 00:14:17,950 headwinds that one needs to think through, 379 00:14:18,410 --> 00:14:19,629 from the health care landscape. 380 00:14:20,595 --> 00:14:22,274 I love that. I think all those things 381 00:14:22,274 --> 00:14:24,595 you mentioned are are so critical, and especially 382 00:14:24,595 --> 00:14:26,595 the workforce piece. That's something I hear time 383 00:14:26,595 --> 00:14:28,995 and time again from leaders across the board 384 00:14:28,995 --> 00:14:30,054 who are trying to 385 00:14:30,754 --> 00:14:33,814 design a system of more collaboration, more alignment, 386 00:14:33,875 --> 00:14:36,470 more, connecting points between physicians, 387 00:14:36,769 --> 00:14:39,169 APPs, and and clinicians across the board and, 388 00:14:39,169 --> 00:14:41,570 you know, their nonclinical counterparts as well to 389 00:14:41,570 --> 00:14:43,029 make this whole system work. 390 00:14:43,809 --> 00:14:45,889 I'm curious. What do you think the hardest 391 00:14:45,889 --> 00:14:47,250 thing you'll have to do in the coming 392 00:14:47,250 --> 00:14:48,070 year will be? 393 00:14:48,475 --> 00:14:50,394 That's a tough question because there are so 394 00:14:50,394 --> 00:14:52,815 many things that are coming down the pipe. 395 00:14:53,434 --> 00:14:55,615 But I think the most important, 396 00:14:56,475 --> 00:14:59,134 thing will be driving behavior change at scale. 397 00:15:00,235 --> 00:15:01,695 At the heart of our mission, 398 00:15:03,159 --> 00:15:05,959 we have an unwavering commitment to bring high 399 00:15:05,959 --> 00:15:06,459 reliability, 400 00:15:07,879 --> 00:15:09,579 which really means we are pursuing 401 00:15:09,959 --> 00:15:13,240 zero harm and embedding safety in every aspect 402 00:15:13,240 --> 00:15:15,079 of our care because we believe that that 403 00:15:15,079 --> 00:15:16,699 is the driver of trust. 404 00:15:17,794 --> 00:15:19,735 Achieving excellence without exception 405 00:15:20,514 --> 00:15:23,014 every time is not just an aspiration, 406 00:15:23,394 --> 00:15:24,934 but it is a core expectation 407 00:15:25,554 --> 00:15:26,454 of our leadership. 408 00:15:27,075 --> 00:15:29,394 Our CEO has set the stage in terms 409 00:15:29,394 --> 00:15:30,774 of what is important, 410 00:15:32,160 --> 00:15:34,879 and the entire executive leadership team is working 411 00:15:34,879 --> 00:15:37,220 on excellence without exception. 412 00:15:37,840 --> 00:15:40,320 And when I mention zero harm, I'm not 413 00:15:40,320 --> 00:15:41,300 talking about 414 00:15:42,960 --> 00:15:43,940 zero events, 415 00:15:44,774 --> 00:15:46,315 but really talking about 416 00:15:46,774 --> 00:15:47,754 zero errors 417 00:15:48,054 --> 00:15:51,254 from the standpoint of zero harm. And we 418 00:15:51,254 --> 00:15:54,475 wish to ensure that every patient, every family, 419 00:15:54,855 --> 00:15:56,794 every team member can trust 420 00:15:57,174 --> 00:15:59,914 that their well-being is our highest priority 421 00:16:00,639 --> 00:16:03,440 And that our systems, our process, and the 422 00:16:03,440 --> 00:16:05,379 culture are aligned to support 423 00:16:05,839 --> 00:16:06,339 safe, 424 00:16:06,639 --> 00:16:10,000 reliable, and exceptional care at every encounter. So 425 00:16:10,000 --> 00:16:10,820 that probably 426 00:16:11,200 --> 00:16:14,000 is the biggest piece. All of those are 427 00:16:14,000 --> 00:16:14,500 behavioral 428 00:16:15,254 --> 00:16:15,995 change elements 429 00:16:16,295 --> 00:16:17,514 because it needs 430 00:16:18,134 --> 00:16:19,355 both our clinicians, 431 00:16:19,975 --> 00:16:22,634 our nursing teams, as well as our entire 432 00:16:22,695 --> 00:16:23,195 staff 433 00:16:23,575 --> 00:16:24,394 to rethink 434 00:16:24,855 --> 00:16:26,154 long standing habits. 435 00:16:26,615 --> 00:16:27,674 When do we intervene? 436 00:16:28,230 --> 00:16:29,769 How do we talk about prognosis? 437 00:16:30,389 --> 00:16:31,929 How do we define success? 438 00:16:32,549 --> 00:16:33,929 What really matters? 439 00:16:34,629 --> 00:16:37,129 How do you understand this from an empathetic 440 00:16:37,589 --> 00:16:38,089 angle? 441 00:16:38,470 --> 00:16:41,909 And then stop being heroic or reactive, but 442 00:16:41,909 --> 00:16:43,769 really focusing on being intentional, 443 00:16:44,575 --> 00:16:45,634 and anticipating 444 00:16:46,414 --> 00:16:48,355 care and providing that care 445 00:16:49,134 --> 00:16:50,274 with hope and compassion. 446 00:16:50,735 --> 00:16:53,455 So that's really the fundamental change. So changing 447 00:16:53,455 --> 00:16:56,174 culture is probably the most important thing in 448 00:16:56,174 --> 00:16:56,834 my mind. 449 00:16:57,720 --> 00:16:59,720 I love that. And I know much easier 450 00:16:59,720 --> 00:17:01,659 said than done. And when you look at 451 00:17:01,799 --> 00:17:04,440 that culture change needing to make the shift 452 00:17:04,440 --> 00:17:06,680 and wanting to zero in on that high 453 00:17:06,680 --> 00:17:07,180 reliability, 454 00:17:07,720 --> 00:17:10,140 zero harm, culture and mission, 455 00:17:10,964 --> 00:17:12,484 how do you do that, 456 00:17:12,884 --> 00:17:15,444 in, you know, have that mission out in 457 00:17:15,444 --> 00:17:16,345 front of folks, 458 00:17:16,724 --> 00:17:19,224 communicate that, and then really hold that bar 459 00:17:19,285 --> 00:17:21,845 high, as you're going through these changes in 460 00:17:21,845 --> 00:17:22,404 in in different 461 00:17:23,869 --> 00:17:25,630 team members might be in in different places 462 00:17:25,630 --> 00:17:27,549 in terms of how easily and and quickly 463 00:17:27,549 --> 00:17:30,029 they can adapt and others who maybe are 464 00:17:30,029 --> 00:17:31,710 holding on to the way they always had 465 00:17:31,710 --> 00:17:34,670 done things, differently. So, I'm curious. How do 466 00:17:34,670 --> 00:17:36,190 you manage all of that, especially in an 467 00:17:36,190 --> 00:17:38,255 environment as we talked about that, you know, 468 00:17:38,634 --> 00:17:41,355 finances are tight, a lot of changes in 469 00:17:41,355 --> 00:17:42,955 all the other dynamics that are happening in 470 00:17:42,955 --> 00:17:44,255 the health care space today? 471 00:17:44,634 --> 00:17:46,955 Yeah. As I shared before, our CEO as 472 00:17:46,955 --> 00:17:48,715 well as the executive leadership team has made 473 00:17:48,715 --> 00:17:51,559 complete commitment to that. So, basically, we are 474 00:17:51,559 --> 00:17:54,759 bringing all our leaders for training on HRO 475 00:17:54,759 --> 00:17:56,380 and zero harm. 476 00:17:57,080 --> 00:17:59,799 Every staff member with about 1,100 477 00:17:59,799 --> 00:18:00,299 sessions 478 00:18:00,759 --> 00:18:02,859 are going to go through this program 479 00:18:03,160 --> 00:18:04,059 on the education 480 00:18:04,565 --> 00:18:05,944 as well as understanding 481 00:18:07,204 --> 00:18:10,005 what this really means and what should be 482 00:18:10,005 --> 00:18:12,565 the change in the strategic mindset to deliver 483 00:18:12,565 --> 00:18:13,144 on that. 484 00:18:13,684 --> 00:18:14,184 But 485 00:18:14,964 --> 00:18:16,724 rooted in all this is the process of 486 00:18:16,724 --> 00:18:19,450 just culture and all the safe tenets of 487 00:18:19,450 --> 00:18:21,630 what a high reliability organization is. 488 00:18:22,330 --> 00:18:23,070 And so, 489 00:18:23,450 --> 00:18:25,710 that's really how we're going about the process. 490 00:18:25,930 --> 00:18:27,529 It's going to be a journey. It's gonna 491 00:18:27,529 --> 00:18:29,769 be a journey of this next year, but 492 00:18:29,769 --> 00:18:31,390 that's really the biggest 493 00:18:31,904 --> 00:18:34,005 area of focus for us as an organization 494 00:18:34,465 --> 00:18:36,545 for this year towards the end of this 495 00:18:36,545 --> 00:18:37,045 year. 496 00:18:37,744 --> 00:18:38,244 Absolutely. 497 00:18:38,545 --> 00:18:40,144 Makes a ton of sense. Thank you for, 498 00:18:40,384 --> 00:18:42,305 sharing with us. Now before we wrap up, 499 00:18:42,305 --> 00:18:43,904 I have one more question. Where do you 500 00:18:43,904 --> 00:18:45,664 see some of the best opportunities for growth 501 00:18:45,664 --> 00:18:47,125 in the coming year or two? 502 00:18:48,599 --> 00:18:50,220 I think I can give a standard 503 00:18:50,599 --> 00:18:52,519 response of saying that, well, growth can be 504 00:18:52,519 --> 00:18:54,519 on clinical excellence, it can be on patient 505 00:18:54,519 --> 00:18:56,440 experience, it can be on value based care. 506 00:18:56,440 --> 00:18:57,880 But I I really think it is at 507 00:18:57,880 --> 00:18:58,619 the intersection 508 00:18:59,160 --> 00:19:01,054 of all these three elements. 509 00:19:01,994 --> 00:19:04,315 Specifically when I think about it, I think 510 00:19:04,315 --> 00:19:04,815 that, 511 00:19:05,355 --> 00:19:06,954 much of the growth has to be in 512 00:19:06,954 --> 00:19:09,375 home based care models where we can deliver 513 00:19:09,434 --> 00:19:11,454 better care and better outcomes 514 00:19:11,835 --> 00:19:13,534 and also on the patient preferences. 515 00:19:16,140 --> 00:19:19,019 We think that there's opportunity for integration across 516 00:19:19,019 --> 00:19:21,359 the continuum. I shared with you how fractured 517 00:19:21,659 --> 00:19:23,679 health care is across the country. 518 00:19:23,980 --> 00:19:26,619 There is opportunity in terms of partnerships, both 519 00:19:26,619 --> 00:19:27,839 external and internal. 520 00:19:28,434 --> 00:19:30,615 We don't need to build every wheel. 521 00:19:30,994 --> 00:19:32,755 We can buy the wheel off the shelf 522 00:19:32,755 --> 00:19:34,375 and actually move things faster. 523 00:19:34,994 --> 00:19:38,115 And then more importantly, developing our leaders as 524 00:19:38,115 --> 00:19:40,515 well as our teams so that they are 525 00:19:40,515 --> 00:19:41,015 comfortable 526 00:19:41,750 --> 00:19:44,490 operating in a space of ambiguity and complexity, 527 00:19:45,029 --> 00:19:48,650 and also recognize our unwavering commitment to 528 00:19:49,029 --> 00:19:50,490 high reliability organization 529 00:19:50,869 --> 00:19:52,650 with safety as its core value. 530 00:19:53,684 --> 00:19:56,424 Ultimately, the growth for us isn't about size. 531 00:19:56,884 --> 00:19:59,764 Right? It's really about impact. And if we 532 00:19:59,764 --> 00:20:02,664 can consistently deliver that care to our patients, 533 00:20:03,524 --> 00:20:06,164 that we would choose for ourselves and our 534 00:20:06,164 --> 00:20:06,664 families 535 00:20:07,309 --> 00:20:09,410 and deliver that excellence without exception, 536 00:20:09,950 --> 00:20:11,089 we will have succeeded. 537 00:20:12,109 --> 00:20:13,869 I love that. Thank you so much, doctor 538 00:20:13,869 --> 00:20:15,789 Murali, for joining us on the podcast today. 539 00:20:15,789 --> 00:20:17,730 This has been such a fascinating discussion. 540 00:20:18,269 --> 00:20:19,549 I I really learned a lot, and I 541 00:20:19,549 --> 00:20:21,390 can tell you're so passionate about what you 542 00:20:21,390 --> 00:20:23,404 do. So, thank you for the time, and 543 00:20:23,404 --> 00:20:24,845 I look forward to seeing you as well 544 00:20:24,845 --> 00:20:26,365 in April. I know you'll be speaking on 545 00:20:26,365 --> 00:20:27,724 one of our panels at the annual meeting, 546 00:20:27,724 --> 00:20:28,924 and so it'll be great to catch up 547 00:20:28,924 --> 00:20:30,684 and dig a little bit deeper into all 548 00:20:30,684 --> 00:20:32,305 of the things we talked about today. 549 00:20:32,765 --> 00:20:35,325 Thank you, Laura. You've been exceptional and kind, 550 00:20:35,325 --> 00:20:36,464 and thanks a million.