← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Matt Boles, MD, MHA, MSc, Chief Medical Officer at Salem Health Hospitals and Clinics
00:26:14
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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 their scenario planning for policy shifts brief breaking through value based care barriers and building clinical teams that translate new ideas into real world care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
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B
This is Laura Deardle with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Matt Bowles, Chief Medical Officer at Salem Health hospitals and clinics. Dr. Bowles, it's a pleasure to have you on the podcast today.
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C
Great. Thanks Laura for having me.
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B
Absolutely. Now I'm excited for our conversation because I know healthcare is changing so much right now and so I'm looking forward to learning more about what you're doing at Salem Health and how you've been successful over the last couple years and how you're thinking about the future too. But before we dive in, can you tell me a little bit more about yourself and Salem Health?
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C
Sure, absolutely. So I'm an anesthesiologist and I'm also the Chief Medical Officer at Salem Health Hospitals and Clinics. And so I've been in my executive leadership role since about 2018, but recently stepped into that CMO role when my dear friend Dr. Ralph Yates retired. But fun fact, I've actually been at Salem Health for 35 years. Started my career here when I was 18, only leaving for medical school and residency. So it truly is an honor and a privilege to serve in this role. A little bit about Salem Health. We lot of people don't know this. You know, we're in the capital city of Oregon, but we're actually the largest acute care hospital in the state. And Salem Health is a level two trauma center. We have over 600 licensed beds, almost 650, a really large catchment area. We go all the way to the coast to the west of us, up the canyon towards the middle of Oregon to our east. So maybe about half a million or so in our catchment area. And I've been told that we're one of the largest cities in the US with only one health health system. And another fun fact about Salem Health is that we have one of the busiest EDs on the West Coast. We saw over 115,000 patients last year and so a very, very busy level 2 trauma center. We do have a small critical access hospital to our west about 20 miles. And then also I think it's important to point out that we are not a teaching hospital. So we have no residents or fellows at our, at our, in our health system.
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B
That's helpful to understand and you know, great context. I mean, I think it's just so impressive to see how many different folks that you do serve within your community and then too like to hear how your career has evolved, you know, from stopping in the hospital when you're 18 and now being a physician and then chief medical officer is truly, truly an amazing journey. I, I can imagine.
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C
Yeah. No, like I said, it's. I never thought in a million years I would be in the role I am. I still practice one day a week. So it's great to be on the front lines with, you know, with all our caregivers caring for patients. So. But no, it is, it's great to be in the community I was born and raised in. I was born in this hospital system. Both my kids were. So no, it is an honor and a privilege.
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B
Fantastic. And you know, when you look at the last year or so, what was the most important initiative you led? What did you do and what were the results?
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C
Yeah, no, I think that's a, that's a great question. And so let me begin by saying I have an amazing executive team that I work with. And so we, we often co lead these initiatives together and I would not be successful without them. And so looking back on this past year, I probably would, would like to reflect on the work we did to employ our anesthesia group. Right. And so when I started my executive journey, I was part of an independent anesthesia group, but I also worked for the hospital in my executive role. And I'd say back in 2022, that's when this work started of moving our anesthesia group to the employed model. Just to give you some context, the group I worked for was out of Portland. Great group, amazing group, one of the largest in the country. But again, they were struggling just like everyone else is with recruitment and trying to keep up with the demands of the contract that they had with our health system. And so they let us know oag the Oregon Anesthesiology Group, let us know that they were no longer able to honor the contract. And so I was led to bring our employed, excuse me, our, our private group to the employed model. And that was a three year journey that just concluded this last fall. And so I learned so Much culturally, professionally, personally, just to bring all of them from this fiercely independent, autonomous model. And what does it look like to be employed in a large health system? And so this was vital to just for the care that we provide for our patients. We could not. We, meaning Salem Health, could not lose this vital service line. And so it was an honor and a privilege to bring them over. And as far as results, I think it really speaks well to our culture and to just what we've really grown here at Salem Health. We had pretty much had everyone, except for two of my partners decide to stay. That just really showcases their commitment to our community, to our health system. And also this work just really showcases that, yes, we have metrics, we have goals, we have targets, but this took a lot of those soft skills of, you know, talking these providers through that journey of becoming employed. So there was hours spent on the. On the, you know, the back end of reassuring them about what does it look like to be employed. Yes, you are losing some of those factors that were in an independent practice, but you're gaining so much more. And so again, that was probably one of the most professionally and personal fulfilling projects that I've led over this past year, which concluded basically this last summer. And then if I could just talk about one more strategic initiative that I helped lead or co lead with other executives was all about procedural capacity. And so let me give you a little more context. We. We have had surgeons over the last several years and other proceduralists say, hey, I cannot get more OR time. I can't get my patients into the or. And so we did some research, some data, and you know, our baseline data did show that we probably had a backlog of several thousand patients waiting for their surgery. And so when we first approached this problem, you know, the easy solution or the solution that we thought was the right answer was just to build more ORs. And as we all know, in the financial landscape that we're in, that's hugely expensive. And so we're a lean organization. And so we use data to drive our problem solving. And so we were able to show that we are actually under utilizing all of our procedural space across the health system. So that started us on a journey of reimagining how we use this procedural space. And so for years, I'd say problem solving in the surgical space really centered on the day of surgery, meaning what can we do for on time starts, turnover times, maximizing our sterile processing or prep recovery areas, et cetera. But we really just stretched that value stream out for the patient, meaning we went upstream all the way to where that patient was referred into the clinics. And so because we have the luxury of having a lot of our surgical clinics being employed, we were able to take that problem solving up way upstream, work with our clinics, and to just really maximize the flow of that patient to our ORs. And here's where we leaned into technology. EPIC traditionally had some great metrics around on time starts, turnover times, etc. Just like I mentioned. But we were able to basically build a procedural traffic control system in epic. And so we could see wherever that patient was on that value stream, meaning all the way back up in the clinic, the time they were waiting to see the specialist, the time that was needed to optimize the patient for surgery, the time that was needed for authorizations and referrals. And so we were able to look at data, how many patients were in each of those buckets. And also that helped focus our problem solving. And so we've had some really good results. We haven't built any more ors. I think that's the number one result to really celebrate because like I said, they're so expensive. But we've maximized our block time with these surgeons. We've been able to create a new system called Patient Case Classification Window, we call it ccw. So we put targets on all of our electively scheduled patients. And so we had an ambitious goal. We wanted all of our patients seen in the clinic to be scheduled in surgery in 45 days or less. And I won't get into all the details, but there are many classifications we can use under that. So globally we are at about 67, 68% of meeting that target, which is a huge improvement from when we started this work. And again, we are now starting to see that backlog that I spoke about being addressed. And so those patients are getting the care that they need in our procedural system. So again, those are just a couple of projects that I can recall again, that I had the honor and privilege to lead with my co executives.
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B
I love that. I think all of those things you mentioned are so critical, especially being able to improve that efficiency. Reimagine the way that you're looking at the space processes, procedures and then the data and having the information that can inform whether you're making improvements and how it impacts quality and outcomes and everything else you know is so critical. I'm curious, as you were making this transformation in putting all of this in place and integrating it into the daily functioning at the hospitals, how did you at the same time go through the Cultural transformation for folks to really embrace all of these things and then make sure that you're getting the outcomes that you wanted.
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C
Yeah, no, that's great. Right? It's part of that change curve. Right. When we had some, you know, surgeons can be, let's say, you know, very emotional and passionate about their patients. And so we had to bring them along, and it took some time. Absolutely. Like I said, we use our Lean management system, and so everything is visible either electronically or in our. What we call our war rooms. And so we would bring our surgeons right along and they would see all the problem solving. And also an important element is that we would include them in on the problem solving. And so, again, using our Lean fundamentals of taking the work to our front line, asking them to be a part of the problem solving, helping us set up targets, our process and outcome metrics, I think that was key. And having several identified anesthesiologists and surgeons kind of champion this work. So it wasn't so much the executive team selling it. It really was those that are impacted by this work. And so, again, that. That, to me, really helped, you know, help. Help make this change easier. And also showing them results, right? Showing them that, yes, you're getting this case in or. We heard you. So we opened up this service line. We had a big bottleneck in robotics, and so we had to reimagine where we were going to do those surgeries. And so we put. Put the robot in a. In a room, in an or. That may not have been everyone's first choice, but we did simulations, we did mockups. And so when we did all those tests of change, we included our surgeons in on that so that they could own it, they could give their feedback, and then they could also turn around and sell it to their section members and practice partners. So it just was critical to get them involved early on.
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B
That is so helpful to understand. Thank you for sharing and talking through that. Now, looking ahead, what are some of your big priorities and headwinds for 2026?
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C
Gosh, where do I begin? Lots of headwinds, I'd say. You know, we're not alone. I think Everywhere and Everywhere is struggling with the payer mix and reimbursements and those issues that are coming especially from our government programs such as Medicaid. And so, you know, it's just the shrinking dollar. Right? Especially from the. The Medicaid program. And I know that in our community, you know, we're just not seeing those rates increase year over year like they need to. To match Inflation and match labor to match all the other costs that are, you know, not just the hospital. You know, we're so big, we can kind of weather some of this a little bit better, but our private groups in town, and so it is really impacting our private practices. And so to give you a. A little bit of perspective, we have had several large practices over the last couple of years that simply couldn't make their books balance, so to speak, and. And their businesses were failing. And so despite, you know, very smart people that were running these businesses, they could not keep up with all of those factors I just mentioned, like inflation and especially labor. That has been a huge, huge driver of cost for these practices. And when you couple that with shrinking reimbursements, it really just made it almost impossible to function. And so we've had a couple of large groups in our community come to us for employment. And again, that's not. Salem Health strategy is to compete in these service lines, but our strategy absolutely is to make sure that these service lines are available to our patients, if that makes sense. We know we need orthopedics in our community. And so when that group approached us for employment, we absolutely worked with them, brought them on board. And. But the, I guess the concerning or the big challenges we're seeing more and more groups do this too. We just did this with our urology group, and so it's not going away, but we're here to, you know, to help the best we can to, you know, bolster these headwinds like you described in the question. But I really think that's. That's our big challenge facing all of us in our community.
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B
I think that's such an excellent point. And, you know, especially looking at how physicians and physician shortages are impacting communities and hospitals and systems across the country, and, you know, bringing those physician groups into employment, I know, is no small task. And then, you know, integrating them financially, culturally, everything else. And so when you're looking at, you know, how you've been able to do this successfully now, a couple of different times, you know, what are your kind of like, business considerations? You're. You're deciding to do that, and how do you make sure that, you know, you have everything in place or what lessons have you learned, I guess, in bringing in those types of groups and making them employed to make sure things go as, well, smoothly as possible?
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C
Yeah, no, we've learned a lot. Right. I talked about the anesthesia model that became employed several years ago. And so, again, we learn through all of our problem solving, like, I Said we're a lean organization, but yes, assimilating into our culture. You know, again, I just want to make sure, you know, our strategy is not to compete or go after these groups, but we really try to put the patient in the middle of all this. What services do our patients need in our community? And so that's, that's really been our approach. They need urology, they absolutely need orthopedics. And so when we take that approach, it makes that work. You know, focused on a solitary mission or a vision, but getting them culturally, you know, into our health system, that's been a challenge. But again, it just takes lots of conversation, lots of time. Sometimes you have to slow down to go fast and just walking through these numbers. Sometimes it's just individually with all of them, keeping everything visible, good communication, follow through, etc. Like I said, a lot of those soft skills that you may not have learned so much in medical school, but it's just, it speaks to that relational side of leadership.
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B
Absolutely. Easier said than done, I know, in many ways, but seems like something that comes naturally to you or did you have to acquire skills there too?
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C
Oh, I'm always learning, absolutely. Asking for feedback. But yes, you know, there, there really is. There, there are people, there are humans behind all of these decisions that we make. And so again, I keep talking about lean. One of our fundamental pillars is respect for people. And so we really do honor that in all that we do. And walking these people through these changes is, is not easy, but it's essential to get them to where they need to be.
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B
Absolutely. I definitely agree. Now, when you're looking ahead too, what do you think the hardest thing you'll have to do in the coming year will be great?
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C
Well, I don't want to be doom and gloom. I do think a lot of healthcare is really hard right now. So, you know, there's pressures and challenges on all fronts. So I'd say maybe the hardest thing that we have in front of us is just to make sure that we stay true to our mission and serving patients and really kind of getting back to why we're, why we are all doing this. And so, for instance, I love when young people come and shadow me in the or, or ask me about my profession. It kind of reminds me of why I even stepped into all of this. So. So I just, you know, I think our challenge is, you know, how do we keep this fresh, how do we make this rewarding? How do we just remind ourselves that our patients are benefiting from what we do? Just earlier today, I was at the nephrology section meeting. And so they're such a great, amazing group of individuals. And so it was refreshing to see them not jaded by all of those challenges I just mentioned. And they were excited to share with me some innovative and creative ideas they had about certain barriers and problems that they were experiencing. So. So I guess, you know, some of the challenges that I think that we face as leaders is let's not lose sight of, you know, why we're doing this, and it's for the patient. And so if we kind of keep that in mind, then I think all those other things will follow. And so, you know, how do we care for those who care for the patient? And so it just kind of expands from there. So that. That's a challenge. We do get kind of focused on our problems. So how can we keep that. That true north, that positive mission statement of caring for our patients?
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B
That is such a helpful reminder. And especially, you know, today, in thinking about all the different pressures and things that are going on for health care providers, being able to really craft that type of environment, atmosphere, and culture where they feel supported can be so critical. And I think when you're looking at, you know, some of those innovations that you've been hearing about creative ideas and other ways to problem solve, does anything rise to the top or come to mind as something that was a particularly unique way that you've been tackling some of these, you know, more physician bonus or clinician, you know, resilience issues?
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C
We are actually learning a lot. And if you want to talk about innovation and creativity, we're learning so much about virtual care. I know we. We did round one of that, right, with COVID I'd say round two is kind of reimagining virtual care in a new way. And so we launched, I think it was about a year ago, maybe a little longer than that, virtual nursing. And so we have actually seen a lot of success there. Our nurses like it, our patients like it, our patient experience scores have grown. And so I would say from a provider perspective, we are taking a deep lean into that work, and we're looking at what our nurses did to make that successful. And so we're just scratching the surface on how can we apply that to provider practices. You know, what does virtual care look like? And again, not necessarily in the way we saw it during COVID but how do we do it in the acute care setting? So I'm really excited for that. I think there's some great potential which will perhaps make care better, more Efficient. It might address the financial questions. And so it could be, you know, the triple or quadruple aim type of innovation that we're looking for. So, yeah, more to come on that. I'm really excited about virtual care.
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B
I love it. I think there's so many opportunities there, and really, it just seems like amazing way to expand access to care and get you in the system into the position it wants to be. Before we wrap up here, are there any other areas that you see as being really primed for organizational growth?
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C
I'd say this is a very small subset of our organization of an important one is our medical executive committee. And we had a retreat this last fall. It was great to get us all together to have some time off site to really have some protected conversation about the challenges that our medical executive committee kind of is seeing or experiencing. You know, we talked a lot about apps, just how grateful we are for them, but also just recognizing that their presence here in Oregon has exploded, it really has, over the last several years and even here at Salem Health. So how can we honor them? How can we support them? How do we balance that independence versus where they fit in the healthcare continuum? How do we help support them with quality of care, et cetera? So that's been exciting. And then it was great to hear from my MEC leaders about how they can impact quality. Not so much in the traditional sense of, you know, problem solving, all those, you know, important measures such as Cautis and Clabsis, et cetera, but to hear from that, that they want to drive the culture of quality. How do they improve that among our medical staff and care team, that was really exciting. So that was refreshing. It was great to have that opportunity with them. And so our next step now is just trying to apply that to some tactical strategy to execute those goals.
- [25:25]
B
I love that. Thank you so much, Dr. Bowles, for your time today. This has been such a fascinating interview. I think you've shared so many different ideas in creative ways that you're problem solving today has just been very inspiring, and I look forward to seeing you as well at our annual meeting in April. I know you'll be speaking on a panel and covering a lot of these same themes, and so it'll be great to continue the conversation.
- [25:46]
C
Great. Thanks, Laura. Like I said, it's an honor and privilege to be here. I'm very grateful.