Dr. Matthew Gonzales, Chief Medical and Operations Officer at the Institute for Human Caring at Providence

Summary

Becker’s Healthcare Podcast Summary
Episode: Dr. Matthew Gonzalez, Chief Medical and Operations Officer at the Institute for Human Caring at Providence
Release Date: June 18, 2025

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Introduction

In this compelling episode of the Becker’s Healthcare Podcast, host Laura Dearda engages in an insightful conversation with Dr. Matthew Gonzalez, the Chief Medical and Operations Officer at the Institute for Human Caring at Providence. The discussion delves into the critical role of human connection in healthcare, the integration of technology in patient care, and groundbreaking initiatives aimed at enhancing patient-clinician interactions.

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Dr. Matthew Gonzalez's Background

Dr. Gonzalez begins by sharing his unique professional journey, highlighting his dual expertise as both an internist and a palliative care physician, alongside his background in software engineering. This combination equips him to bridge the gap between technology and humanistic healthcare, a central theme in his work at the Institute for Human Caring.

Dr. Gonzalez [00:40]: "I bring my physician skills to the mix, but before I was a doctor, I was also a software engineer. I particularly love this intersection of hyper humanistic healthcare and technology."

He emphasizes the rarity of professionals with such a dual background and the value they add by acting as interpreters between the tech and clinical worlds.

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Combining Technology and Humanistic Healthcare

Dr. Gonzalez discusses the challenges and opportunities that arise from integrating technology with patient-centered care. He points out that while technological advancements can enhance care delivery, maintaining the human touch is essential for meaningful patient interactions.

Dr. Gonzalez [02:20]: "A lot of us that are in this intersection are really good at being an interpreter between two worlds. Tech folks and clinicians speak different languages, and we navigate those pieces effectively."

This synergy is crucial for the Institute for Human Caring to fulfill its mission of providing compassionate care to patients with serious illnesses.

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The Study on Goals of Care Conversations

A significant portion of the conversation revolves around a study co-authored by Dr. Gonzalez for the New England Journal of Medicine Catalyst. The study highlights the Institute’s efforts to enhance goals of care conversations, resulting in a remarkable 1,100% increase in these discussions.

Dr. Gonzalez [03:01]: "We increased the goals of our care conversations by around 1,100%. This was driven by our mission to take the best care of patients and understanding them deeply."

Key drivers of this success include:

• Mission-Driven Approach: Emphasizing the organization's commitment to patient-centered care.
• High-Quality Standards: Implementing consistent best practices across the board.
• Technological Integration: Utilizing informatics and analytics to create scalable dashboards.
• EPIC Reformatting: Adjusting the electronic health record system to facilitate easy documentation of conversations.
• Education Programs: Developing advanced communication training for clinicians.

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Scaling Goals of Care Conversations

Dr. Gonzalez elaborates on the strategies employed to scale these conversations effectively across the healthcare system. He underscores the importance of both increasing the quantity and ensuring the quality of these interactions.

Dr. Gonzalez [07:18]: "We went from having these conversations 6.8% of the time to 84.8% in the first year, and from 2% of total admissions to 27%."

The Institute focused on equipping clinicians with the necessary skills and tools to conduct these meaningful conversations, recognizing that merely increasing the number of discussions without quality could be counterproductive.

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Importance of Quality Conversations

The quality of goals of care conversations is a cornerstone of the Institute’s approach. Dr. Gonzalez explains how establishing standards ensures that these discussions are both meaningful and impactful.

Dr. Gonzalez [09:31]: "Patients want to feel heard and understood. When clinicians engage deeply, it bridges the gap and helps patients feel confident in their decisions."

He outlines the criteria used to measure conversation quality, which include:

• Documentation: Ensuring conversations are recorded in patient charts with clear details.
• Participant Identification: Knowing who was involved in the conversation.
• Content Description: Providing summaries of what was discussed.
• Care Level Choices: Offering predefined levels of medical care to guide decisions.

This structured approach not only enhances patient satisfaction but also improves operational outcomes, such as reducing hospital-acquired infections and aligning patient care with their personal values.

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Measuring Success of Conversations

Initially, the focus was on whether conversations occurred. Over time, the Institute refined its metrics to assess the quality of these interactions.

Dr. Gonzalez [09:52]: "We established three key elements: documentation, participant identification, and content description, along with predefined care level choices."

By setting these standards, the Institute could better understand and improve the effectiveness of their goals of care conversations, ensuring they truly serve the patients' needs.

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Impact on Patient Care and Clinician Burnout

Dr. Gonzalez highlights the profound impact these conversations have on both patients and clinicians. For patients, feeling heard and having their values respected leads to improved experiences and outcomes.

Dr. Gonzalez [13:39]: "These conversations are the number one anti-burnout tool for our clinicians. Connecting with patients reminds us why we do our difficult jobs."

Moreover, effective goals of care conversations contribute to operational efficiencies by enabling smoother transitions from hospital to home or hospice care, thereby optimizing resource utilization and reducing the risk of complications.

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Guidance for Other Health Systems

When asked about advice for other health systems aiming to replicate Providence's success, Dr. Gonzalez offers practical steps based on their experience.

Dr. Gonzalez [14:19]: "Start with organizational leadership and ground efforts within your mission, vision, and values. Then, build the necessary infrastructure to support these initiatives."

He emphasizes the importance of securing executive buy-in and developing robust electronic systems to facilitate documentation and accessibility of conversation records. These foundational elements are crucial for driving meaningful change at scale.

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Conclusion

The episode concludes with Dr. Gonzalez expressing his willingness to support other organizations in implementing similar initiatives, reinforcing the collaborative spirit essential for advancing patient-centered care.

Dr. Gonzalez [16:39]: "If you want help or need advice on how to do this, we're happy to, because I believe we can all go further together."

Laura Dearda thanks Dr. Gonzalez for his impactful insights, underscoring the relevance of his work for hospitals, health systems, and caregivers striving to enhance the quality of patient interactions and overall care delivery.

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Key Takeaways:

• Human Connection: Central to effective patient care, especially for those with serious illnesses.
• Integration of Technology: Facilitates scaling and quality assurance of care conversations.
• Quality Over Quantity: Ensuring conversations are meaningful enhances patient satisfaction and clinical outcomes.
• Clinician Support: Structured, empathetic interactions serve as a buffer against burnout.
• Leadership and Infrastructure: Essential for successfully implementing large-scale care initiatives.

This episode serves as an inspiring blueprint for healthcare leaders aiming to foster deeper patient connections and improve care delivery through strategic, mission-driven efforts.

Transcript

[A]

This is Laura Dearda with the Beckers Healthcare podcast. I'm thrilled today to be joined by Dr. Matthew Gonzalez, Chief medical and Operations Officer at the Institute for Human caring at Providence. Dr. Gonzalez, it's a pleasure to have you on the podcast today.

[B]

Oh, thanks for having me. I'm super excited to be here.

[A]

Absolutely. I'm really looking forward to hearing more about your work at the Institute for Human Caring. I know there's so much happening in healthcare today, but it's really truly important to continue to stay connected and foster that human to human connection and interaction that makes such big difference. So I'm looking forward to hearing more about your work. But before we dive in, could you introduce yourself and tell us a little bit more about your background?

[B]

Sure, yeah. Happy to. And I couldn't agree more that human connection is so, so important at this point in time. My, my background is I'm a internist and palliative care physician. I have the privilege of leading something called the Institute for Human Caring. We were established 11 years ago by Dr. Iraq with really this vision for Providence to take the. Of people who are living through serious illness. And we've been spending, you know, the last decade plus trying to figure out how to do that. Well, I of course, bring my, my, my physician skills to the, to the mix, but before I was a doctor, I was also a software engineer. And so I particularly love this intersection of hyper humanistic healthcare and technology. And trying to figure out how we, how we do both well at the same time was. Can be hard sometimes.

[A]

Yeah, absolutely. And you know what, a combination of backgrounds and skill sets going from software engineer to a physician. How many other people have taken that route, do you think?

[B]

I know of a few. We are all, as you might imagine, a little bit, bit close. There's a strong nerd thread that runs through that. But, but we love each other and amplify each other's thoughts and it's, it's super fun. What I appreciate a lot about it is that even though I don't get to code as much, I think a lot of us that are in this intersection are really good at being an interpreter between two worlds. I think a lot of folks recognize that sometimes tech folks and clinicians speak different languages. And so those of us that have done both can be effective at navigating some of those pieces.

[A]

Absolutely. And you know, that's such a great point that you've got that ability to cross between the technology and healthcare. And I know that really dovetails nicely into the work that you're doing with the Institute for Human Caring. You recently co authored a study for the New England Journal of Medicine Catalyst, highlighting, you know, some of the work that you're doing at Providence, especially around, you know, connecting with patients. And you found actually a way to increase the goals of your care conversations by around 1100%. What were the main drivers behind that dramatic shift? Can you tell me about the study and really how you achieve these outcomes?

[B]

Sure, yeah. We are just unbelievably proud of the effort. 1,100% is a large percentage increase and it, it took obviously a group of learnings, both, both things that we did well out of the gate and some things, you know, that we had to learn from as we were continuing along this journey. I think the main drivers that were so, so important is that, and I'll just give a shout out to Providence as the start, which is that I really believe that we are a mission driven organization that's committed to getting this care right at a time that's difficult within healthcare, when there's so many challenges for us all to think about, to double down and to continue thinking about how we take the best care of patients and families who are seriously ill. The focus of this effort really was having really good conversations with patients and families when they were seriously ill in our hospitals, with a particular focus on people that were in the ICU for a long length of time. But, you know, not every health system out of the gate has the bandwidth to do that. But I'm so grateful to Providence and to the executive team support and leaning into this, the mission drivenness of this, the alignment that in order to take the best care possible of our patients, we have to know and understand them. I think that was, that was a huge, huge part of our work. Of course there's, there's other, more operational pieces. You know, we did things like proposed really high quality standards to make sure that we were getting consistent best practices. We worked with our informatics and analytics colleagues to be able to create meaningful dashboards that could scale up or down to assess progress. We reformatted EPIC to make it easy to put these conversations in. And lastly, I think one of our keys to success was creating a scalable education program or advanced communication training that helps clinicians feel more comfortable in having these conversations.

[A]

That's fascinating to hear and, you know, it seems like a really valuable tool to have and then be able to impart with the clinical team. So I'm curious, could you tell us a little bit more about the education program and what really you're getting at with, you know, connecting on those discussions and helping them, you know, rethink about how they're framing it and really approaching some of those challenging discussions that they might have with patients and their families.

[B]

Such a great question. And it's so important, right, because just raising the number of conversations that happens is one thing, but really trying to do those well is another. And just, just to say, I mean, we went from, you know, 2017 numbers of having these conversations in our long length or stay ICU patients 6.8% of the time to last year, hitting 84.8% initial year. We went from about 2% of our total hospital admissions having these convers conversations to 27% last year, which is like just about 100,000 conversations. So like nearly one in three hospital admissions, which is just remarkable. But we didn't want to just like have a setup where we ask clinicians to do something different without helping to equip them. You know, when I was in medical school, I had a total of 15 minutes of education around how to have these conversations. Well, 15 minutes total, like start to finish. And I think all of us have been on the receiving end in our personal lives of having these conversations gone wrong. So for us, we felt like we had to, we had to help clinicians be able to respond with more empathy and to be able to teach them skills to be able to do this well. Because the truth is, when someone's sitting there in front of you and looking in the eye and saying, am I going to die? Is that what you're telling me? Being able to respond with honesty and empathy and being able to hold that space, it takes time to be able to learn that skill and to be able to do that well so that we help our patients process this information rather than hurt them with the share of information.

[A]

That's such a great observation and definitely is something that makes a big difference within the whole care process process and the journey for the patients and their families. And really truly I can imagine is very welcome change for the clinicians as well to have that experience and empathy behind them. You know, it is never easy, but can truly, you know, take some of that challenge and turn it into a meaningful conversation. I'm curious, why are the goals of care conversations so pivotal in advancing the person centered care that Providence wants to achieve and how do they contribute to meeting some of the broader quality goals as well in healthcare delivery?

[B]

Oh, I, you know, I think one of the most important things that, that we have learned in doing this work is that patients want to feel heard and understood. And when they're facing difficult decisions, that one of the things that helps them feel confident in what they're going to do and how they're going to leave their life is really us taking the time to do that well. And you know, I think it's clear from a number of academic studies that there really shows that when you have these conversations at a deep and meaningful level and engage with people, that essentially clinicians are able to bridge that gap and to be able to help people feel heard and understood. And when that happens, a lot of the other things that healthcare focuses on right now, like for instance, the patient experience gets better, or for instance, patients are able to transition home outside of a hospital to something like a home hospice program because it aligns with their goals and values after they've had time to think about it. And that's also a whole host of things, right? In terms of operational outcomes, it not only helps get people out of our hospitals so that we can get people into them where we need to take care of them, but it also reduces, for instance, their risk of getting hospital acquired infections and all of the more traditional standard metrics that we look at within healthcare.

[A]

That makes a lot of sense. I appreciate everything that those transition, these conversations touch within the care process. When you're looking at these benefits, how do you measure the success or quality of these goals of care conversations? What are the outcomes that matter most to patients and providers?

[B]

Such a good question. So what I would say is initially we started with a baseline of did this conversation happen or not? And that's because when we started this road, it was like 2015, 2016 is when we really started diagramming this out. And at the time, our technology really allowed us to answer the simple question of did a conversation happen or not? We didn't look at quality. One of the things that we learned with time though, is that we really needed to focus in on that and to try to understand and establish some standards. In 2020, we brought together a group of Providen system leaders, ethicists, clinicians, to really think about what it meant to have a quality conversation in this way. And we established really three things that felt really important. Reading the note, reading the documentation in the chart. Did I know who you talked to? Was it your mom, your sister, your brother? Who was it? Or was it you? The patient? What did you talk about? Some description, it didn't have to be a novel, but something that tells me a little bit about what you talked about. And then one of four pre selected choices for levels of medical care which were all okay. Anything from desiring all treatments, full treatments necessary, down to focusing on a more comfort or care level of care for allowing a natural death and really two levels in between there. So it allows for some granularity. And what we found is by doing that, it allows us to establish a floor for understanding what was talked about and what is meaningful to people. Of course, in our classes where we teach these topics, we also encouraged talking about and including things like what are people's sources of strength? What are their hopes and wishes for the future now that we know that things might be tough, what are they worried about in the context of a serious illness? I think by establishing a baseline floor and then encouraging people to add this robustness really helped us to encapsulate, I don't want to say the entirety of the human experience because it's not that, but it certainly helps to deliver our patients from anonymity and try to understand what really matters to them. Which for me, if you ask me, what is the outcome that really matters of that once you define those quality standards? I think for patients it's what I said earlier, which is feeling heard and understood that that's what I want when I'm visiting my primary care doctor, I want to feel like what I'm sharing matters to him and he's able to understand that. I think when I'm in my doctor role, what is, what is meaningful when we have these conversations? Well, I think it's a lot about feeling like we're doing the right things for our patients, like they have the information that they know they need to be able to make a good decision, that we're thinking it through together as part of shared decision making and that we end up coming up with a plan that is the right thing for them. But beyond that, I would just say that these conversations are so, so important for us because they are to me, the number one anti burnout tool that we have for our clinicians. Traditionally, we've taught that connection can be bad in health care and dangerous to doctors. I think the exact opposite is true. That when we connect with the people that we're caring for and understand who they are, that that helps remind us why we're doing these difficult jobs and why we're caring for people. And that's a huge remedy for some of the burnout epidemic we're seeing right now.

[A]

Well, I think it's such an important reminder of what you're doing every single day and how that really feeds into the clinical leaders in those who are working with patients and can be a huge part of what hospitals and health systems are able to provide support to their caregivers in navigating these types of conversations, these types of situations, to truly ensure the longevity and sustainability of the broader healthcare delivery team. Before we wrap up here, I'm curious, for health systems that want to emulate Providence's approach, where should they begin? What are some of the foundational elements that they need to drive change at this scale?

[B]

Such a good question. We debated this a lot early on and we made some mistakes. So I would just say that looking back on this project eight to ten years later, I would start where we started, which is begin with organizational leadership and ground efforts within this, within your own organization's mission, vision, and values. You know, those words are not just words on a page. They are a living, breathing sentiment of who we are. And so if we can lean into those and connect these conversations to what really matters, I think that that that is the first and most powerful thing that we had going for us, whether it be our executive leadership or for instance, which is my second thing, is build the infrastructure before you do a launch. You know, EPIC didn't work for us. Totally out of the box, and it works much better now. Not to malign epic, I think they're actually been incredible partners around this. But in terms of trying to create an infrastructure that clinicians can, for instance, record these conversations in an electronic format and make it easy for them to put in and easy for other clinicians to find. That took us some work back in 2016. And so I would say that, like, grounding within the mission, though, is so easy to go to the IS team, our information services team, and say, how are we delivering on these pieces? I can help you deliver on these by engaging with this effort to make it easy to find people's personhood and what matters to them in these conversations. So, number one, start with buy in, lean into your mission, vision and values to try to figure out how we talk about this. And then number two, build the infrastructure that's needed. Then beyond that, certainly all the other things that can be done around pilot work and the like. But those are, those are my top two places to start for folks.

[A]

Yeah, absolutely. I love that. And what an inspiring story. Dr. Gonzalez, thank you so much for joining us on the podcast today. This has been such an impactful conversation, really powerful topics that are meaningful across the board for hospitals, health systems and caregivers. So I appreciate your time and look forward to connecting with you again soon.

[B]

Oh, thanks, Laura. I really appreciate it. And I would just say, for those of you listening, if you want help or need advice on how to do this, we're happy to, because I believe we can all go further together.