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Becker’s Healthcare Podcast
Dr. David Marcozzi, Chief Clinical Officer at University of Maryland Medical Center and Associate Dean of Clinical Affairs at the School of Medicine
00:19:57
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- [00:02]
A
Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit Beckershospitalview.com and click on the Events tab in the upper right.
- [00:38]
B
This is Laura Deardo with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Dr. David Marchozzi, Chief Clinical Officer at the University of Maryland Medical center and Associate Dean of Clinical affairs at the University of Maryland school of medicine. Dr. Marchozi, it's a pleasure to have you on the podcast today.
- [00:53]
C
Laura. Thanks for thanks for asking me to be part of this.
- [00:57]
B
Absolutely. Now, I'm excited for our conversation because I know things are changing so quickly in the healthcare space and I'm excited to learn more about some of the things you're doing at the University of Maryland. But before we dive in, can you tell me a little bit more about yourself and the health system?
- [01:11]
C
Sure. Well, as the Chief Clinical Officer for the flagship academic medical center within our system, I work in partnership with our Dyad, my strongest Dyad partner, our CNO, Dr. Karen Doyle, and many portfolios the that include clinical strategy, operations, quality, safety, graduate medical education, credentialing of our providers and candidly, physician alignment and care transformations across two campuses. And the medical center comprises two campuses and in those campuses there are two hospitals. So the work that I do services for our flagship as one of the largest and most complex academic medical centers in the region, it delivers care to some of the highest acuity patients in the nation per Vizient's Q&A Quality and Accountability ranking. And my role bridges strategy and execution, partnering with physicians, nurses, operations and analytics to translate organizational priorities into reliable, high quality care at the bedside. The medical center includes about 800 beds downtown and 140 beds in Midtown. Those are the two campuses with over 1200 attending physicians and close to 900 residents and fellows. We deliver highly specialized high acuity care spanning trauma, cancer, neurosciences, transplant and more. All of our physicians are faculty within the University of Maryland School of Medicine, tightly linking education, discovery and care. We've got some high rankings including our academic flagship scores very highly in the Vizient Quality and Accountability ranking in comparison to other academic medical centers. We've scored on some of our Specialties high on U.S. news and world Report. And we're also very proud of our four time magnet designation which is really among some very small percentage of hospitals across our nation for nursing excellence. So Laura, a lot going on at the medical center and thrilled to talk to you today.
- [03:09]
B
Well, that's amazing to hear and what a broad enterprise that you have on Maryland is. Amazing to see all the different elements coming together and really truly serving the community in a strong way. Now when you think about the last year or so, could you tell us about an initiative that you led? What did you do and what were the results?
- [03:28]
C
Yeah, you know, I'm going to ask for some latitude, I'm going to speak on not just one, but two. Our medical center is really focused on delivering the highest quality and the safest care. And we started to implement a conceptual framework called hro High reliability organization. And really made it part of the fabric of how we deliver care and made it essential to how we think about day to day practice. And that meant standardizing how leaders engage with safety data, responding to events rapidly and escalating risk. In accordance with our protocols and policies, we embedded the five principles of HRO into executive routines, unit level governance and frontline workflows. So it went from the bedside to the boardroom. Practically this included restructuring leadership, safety reviews, clarifying escalation cascades, reinforcing just culture expectations and holding dyads and triads. The triads are nurse practitioners pas on units accountable for consistent safety behaviors at the unit and service levels. And this really anchored, was anchored in a rollout that we were doing across our system, something called continuous learning for improvement. And that is education and applied, using application strategies at the unit level and understanding lean strategies or performance improvement, educational training opportunities to be applicable at the line at the unit so we can have the greatest impact of where the work is done. Our results for HRO have been meaningful, but we all know HRO is a never ending effort. So we saw improvement in our safety reporting. We have tangible examples of improved relationships between our dyads and triads and understanding what their priorities are, broader understanding of the data and more consistent leadership at the unit level. And then finally very clear ownership of safety issues and faster escalation and resolution of risks. The second thing I'll talk to is about the work around access to the academic health system. This was a really major focus for our system and is particularly relevant for patients requiring highly specialized time sensitive care as we are all experience across our nation. Really a supply and demand mismatch for Healthcare demand versus the supply that we have to provide that care. So we took that challenge head on by innovating how we move patients through the system to provide earlier access to academic level care with a specific focus on round trip transfers that enabled greater access to care without the constraint of an inpatient bed. And really, over the past year, the medical center has managed hundreds of round trip transfers for a high acuity, high acuity care across our system. This was done through clear standards engaged for our physicians in how we're going to do this. So there's clear expectations set. Really we needed to improve our systemness and we have very disciplined operational oversight of all of our requests that were made to the medical center. 70% of those requests for round trips were successfully completed, some of them, the other 30%, some of them were not needed, some of them we managed via telehealth. So we're really trying to think about a systematic way to get access to high acuity care that our medical center can provide, but not limited by bed capacity. And this has improved flow across our University of Maryland system and region. And it puts what we feel as though it puts care at the right location at the right time for our patients. So that's just two efforts that we've embarked on. We've embarked on a lot of efforts, but those are two I want to highlight today. Lara.
- [07:23]
B
Well, that's amazing to hear. Both are impressive in terms of looking at the scale that it takes to really have some of those changes on the clinical workforce team, make sure they've got the right structure in place for safety, reinforcing that culture in bringing them all together for high reliability organization. And then secondly, looking at the things that you were talking about in terms of making sure, expanding access to care, managing transfers and doing things a little bit differently, the results are impressive. I think in both cases it seems like it took some change, not only from the process and procedure side, but also, I'm sure, from the culture side and how the clinicians were approaching their work. So how do you do some of that change management with the broader teams and just make sure that everyone is on the same page and doing the right things?
- [08:13]
C
Yeah, clarity of expectations and roles was really one of those key fundamentals of who owns this, what is the work that needs to get done, how do we support that work to assure that the data is understood, then drive? The term I like to use quite often in many meetings that we have is decisive collaboration. In academia and certainly academic medical centers, we sometimes wonder who's making the decision, how is the decision made and the process for that decision. What we all have started to anchor on is we, we embrace a who is the lead for this decision, how are we collaborating to make that decision? But we will make a decision to move forward and allow us to continue to evolve. And we're not paralyzed by indecision. And that was really one of the things. And then when we put on that the priority of HRO was much clearer understood from a structure standpoint, how we're gonna make decisions and who's making them, from a process standpoint, a prioritization standpoint, what the process and the priority HRO and highest quality. And then the outcomes we're seeing throughout our hospital of folks understanding and escalating concerns. And it's having really a broad impact to patient care across our medical center.
- [09:34]
B
That's amazing to hear. Thank you so much for digging a bit deeper there. Now, looking ahead, what are some of the big priorities and headwinds you're focused on for 2026?
- [09:44]
C
Yeah, Laura, Maryland is quietly doing what the rest of the country continues to think about. And we are using what's called the Maryland Model, a waiver that was granted by the federal government CMS to support a statewide health care global payment and accountability system for our state's health care. And that has substantively shifted volume to value. And it has better aligned hospitals with physicians and communities. And the emphasis for this Maryland model has been around keeping people healthy and assuring that our quality is the highest within our state. And lastly, the Maryland model has demonstrated also it is starting to bend the cost curve. And Maryland continues to push that envelope forward. And in partnership with our federal government, we are going to be soon to innovate further than what we've done historically in the Maryland model and adopt the all pair evolution of the AHEAD model. For more than a decade, our state has demonstrated that it is possible to control healthcare costs while improving quality and addressing population health outcomes. And that's a result that we feel as though many states and federal partners now view as a blueprint for national reform. The upcoming AHEAD Model I'll just quickly speak to that because not a lot of folks know about it, but our state is certainly embedded in executing this successfully. The upcoming AHEAD model builds on the foundation of that Maryland model that I to around total cost of care by providing and expanding the accountability beyond hospitals to total cost of care, quality and equity across defined populations. It now makes even greater emphasis on prevention, care coordination and appropriate utilization where that utilization is best served by the patient and the care providers. And finally, it holds systems accountable for those outcomes that extend far beyond simply the hospital walls. So really, Maryland is innovating. We realize ahead is a new frontier for us. Our Maryland model continues to evolve, and we think we serve as a potential beacon for how we can shape healthcare delivery across our nation. So what's that mean for our medical center? We're continuing to evolve how we deliver care. In fact, it's an imperative. Tighter clinical integration, stronger partnerships across the continuum of care, from the outpatient side to the inpatient side, and then back to our outpatient community. We really need to double down on how we're thinking through patient flow. And lastly, we have to have a disciplined approach to limiting care variation. So standardizing care models, clinical practice guidelines, putting those in place, I'm not going to make any. The financial pressures are real. Workforce fatigue continues rising. Acuity, as I mentioned, the medical center is the second highest acuity, medical center, academic medical center in the nation. So we have our challenges. I'm not going to say that we don't, but the challenge is executing at a high level locally while helping shape a model that could inform healthcare deliver nationally. So we feel as though we really at the tip of the spear with regard to where healthcare is going and really take that responsibility on with great excitement.
- [13:03]
B
That's great to hear and I think super exciting around both initiatives. I think, as you mentioned, is something that so many different hospitals, health systems, and states have been trying to figure out how to do smartly and in the right way. And so it's fascinating to hear a little bit more about how you're doing things in Maryland and the outcomes for patient care, it seems like, has been really beneficial. So, you know, when you were making these transitions, what did you have to do or what did you learn about going from the traditional fee for service to more of these types of payment models and ways of thinking about care episodes.
- [13:41]
C
Well, yeah, thanks for asking that question. I think that one of the things that, you know, Maryland, when folks interview for positions here, we are, one of the questions we always ask is, do you know Maryland's different? We always, you know, our physician colleagues, our nursing someone always ask, well, how? And I said, well, the Maryland model really governs how we think about delivering healthcare, about better outcomes, higher quality, but also around how that's linked to cost and, and how that cost curve can be bent by better outcomes, greater access into the ambulatory sector, so that patients who receive care in the inpatient sector are the folks who really need that care. But supporting health overall outside the four walls of our hospital is really a mind shift change for folks who might be coming in here in a typical fee for service model. One thing I'll just highlight is the emphasis around how our physicians and our hospitals work together to achieve what we're talking about now is improved outco. So our hospitals across our state are capitated, so we have a global budget for our hospitals. Our physicians are still fee for service. So it really emphasizes the importance of the work that we all do for physician leaders inside our state to align how our practices and our physicians think about delivering care inside our hospital infrastructure that has a global budget and then aligning not only care quality, operations and system design with how our practices are delivered care inside their walls. And that synergy has to be thought about with every decision we make with implementing the models like we have with the Maryland model and the HEAD model upcoming. So to me, the model helps importantly recognize the partnership between providers and hospitals moving forward. That's been one of the anchors that I found in this job that is really essential to moving healthcare forward.
- [15:38]
B
That's helpful to understand. I mean, you know, really, really interesting context to think about how Maryland is doing things differently and what it means for the patients. Now when you look at the next year too, what do you think the hardest thing that you'll have to do will be?
- [15:50]
C
Yeah, well, I just mentioned we have got a lot of, we've got a lot of changes in healthcare coming. And I think healthcare, one of the only thing I, one of the things I quite often say is the only constancy in healthcare is change. And that's where we're so this year upcoming, I think the hardest challenge will be continue to innovate at a time when everyone in healthcare is carrying some degree of fatigue. You know, the need to evolve, as I just spoke to, clinically, operationally, technologically is unavoidable. It's all driven by the access pressures, workforce constraints and new accountability models, just like ahead. But at the same time, we must be deliberate about how we introduce change and how it's paced. And that balance is so critical. Our team members are our most vital strength and sustained performance depends upon their well being. The work ahead requires prioritization that truly matters. Eliminating low value work and ensuring that innovation makes care better and work more sustainable, not harder. Leading through that tension with clarity and empathy will be one of the most important responsibilities this upcoming year. Laura. So balancing innovation with assuring that we have workforce support and wellness is one of the gauntlets that we make sure we carry is the medical center leadership team moving forward.
- [17:12]
B
That makes a lot of sense. It is really a helpful foundation to think about preparing your teams for any types of uncertainties or new things that come your way. So that's really, really helpful to see. Now, when you think about growth as well, where do you see some of the best opportunities for the health system in the next year or to continue growing?
- [17:33]
C
I think my perspective maybe I'll triangulate some of the things we've kind of talked about previously in the conversation for this question. I think one of the strongest opportunities lies at that intersection of workforce sustainability, implementation of the AHEAD model, and a concept around automation. AHEAD is going to require us to think about total cost of care not only inside the hospital, but outside the hospital, assuring highest quality and ensuring we address a degree of workforce support to do that work moving forward so we're able to have a successful implementation. Key to this will be how we think about where the right work is done by the right person at the right time. Automation and responsible use of AI could allow us to redesign care so clinicians and staff can operate at the top of their skillset. I don't think we think we are embracing that entirely. As healthcare delivers care right now for patients, this means improved and easier access, smarter triage navigation across our care continuum, and multimodal forms of communication. For care teams, it means decision support for triage diagnosis and management planning along with automation of low value administrative work that contributes to our staff's burnout. I think our efforts will directly support workforce retention if we're able to implement the things I'm speaking to. Because when team members spend more time delivering care and less time battling administrative systems, our engagement rises, turnover drops and folks are just happier coming to work. And as we adopt the AHEAD model, triangulating that with the AHEAD model moving forward, changes like this in concert will be essential to maintaining a stable and supported workforce, which is to me fundamental to our imperative for high quality care and our provider and staff wellness.
- [19:31]
B
Absolutely. Well, fantastic I think. Thank you so much Dr. Narcosy for joining the podcast today. I really appreciate your time and effort and I look forward to seeing you at our annual meeting in April. I know you'll be speaking at the event and so this will be a great opportunity for us to share and continue to learn more about everything you have going on in Maryland.
- [19:50]
C
Laura, appreciate you. Happy Wednesday and look forward to seeing at the conference.