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Becker’s Healthcare Podcast
Advancing Patient Flow and Clinical Excellence at Atlantic Health System with Dr. Geralda Xavier
00:20:25
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- [00:02]
A
The most important healthcare decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit and more, the conversations get real. Leaders will share how they're scenario planning for policy shifts, breaking through value based care barriers and building clinical teams that translate new ideas into real world care care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
- [00:46]
B
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 Dr. Geralda Xavier, who is a Regional Chief Medical Officer with Atlantic health system. Dr. Xavier, welcome back to the podcast. Thanks for joining us today.
- [01:07]
C
Hey, thanks Mackenzie. I really appreciate you having me on. Hope all is well with you as well. Looking forward to our conversation.
- [01:16]
B
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 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.
- [01:45]
C
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 has certainly helped shape my commitment to serving diverse and voluntary 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 base 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. Over my career I've 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 infection. 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 leapfrog a ATR centers, reducing hospital acquired conditions and really for me really guiding emergency management responses. Well 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 physicians to advance peer review, transparency and enhancing both workforce engagement and satisfaction. So really I believe sustainable excellence in healthcare comes from really 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 healthcare space.
- [05:12]
B
Yeah, I'm looking forward to hearing more about it. I think you paint such a clear strategic vision of this work and what needs to be done to really move the needle for patients in your communities. As you mentioned last time you're on the podcast laid out some information for us in terms of the significant gains you've made in readmissions, particularly for those vulnerable groups. I'm curious now, speaking to you in early 2026, as you reflect back on the past 12 months, what 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?
- [05:49]
C
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 important initiatives 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 any 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, delays in movement, creates risk and is a dissatisfier for our 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 patient flow committee. We brought together stakeholders from across the continuum, such as nurse leadership positions, 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 FLO 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 partnered 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 or stay from an average of 36 to 48 hours to less than 30 hours and have been able to sustain those gains. That improvement alone created earlier better 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, there's shared accountability and everyone's working from the same plan. And really, when done right, interdisciplinary we call idr, arounds can shift culture from the fragmented care to really coordinated, high reliable care that benefits all, including patient and staff. And finally, 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 vetting from the emergency department. We started by just mapping out the process to really understand where the delays in the handoffs and rework occur. 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 EED providers and hospitalists 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. 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 discipline continuous improvement. Overall we achieved a measurable reduction in length to stay from our baseline. We improved admission to bedtime, we shortened observation stays as I mentioned, to 30 hours and under and we improved some other KPIs such as discharge before noon. And that translated to really improve access and decreasing 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. That culture shift 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. This is really exciting work that continues 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 opportunity 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 structure, 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 any of those. So pretty exciting work that we continue to do.
- [12:47]
B
Very exciting work with some significant results. As you said. And I so appreciate your note about the descriptive structure being important, but also 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, say over the Next, you know, 10 months of 2026, what would you say are your biggest priorities and headwinds that you're focused on now?
- [13:22]
C
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 priorities is 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 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. Leveraging workforce experience 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 podcasts and other avenues of communicating with healthcare leaders, I'm sure you hear about workforce fatigue, recruitment pressures and retention challenges and they remain headwinds across the industry. We are focused on engagement, leadership development and creating 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.
- [15:44]
B
That focus is really core to everything, right?
- [15:47]
C
Yeah.
- [15:49]
B
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 going to hardest thing that you have to do over the coming year?
- [16:03]
C
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. Our patients and our teams haven't 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 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 the hardest part is making sure that we make these tough decision making, but in a way that maintains 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.
- [18:14]
B
Absolutely. Dr. Xavier, I'm always just so impressed at your focused approach, your dedication to quality and clinical excellence, and it really shines through in your remarks today. 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?
- [18:39]
C
No, I think again, thank you so much for the opportunity for the conversation. I really appreciate and enjoy 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 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 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 join 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.
- [20:03]
B
We're excited to conferences. Yes, we're excited to have you at our annual meeting in April.
- [20:08]
C
Looking forward to it.
- [20:09]
B
Wonderful. Well, thank you again so much, Dr. Xavier. And listeners, thank you as well for tuning in. You can find more podcast episodes by visiting the Becker's podcast page@beckershospitalreview.com podcasts.