← Becker’s Healthcare Podcast
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- [00:02]
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This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the events tab in the upper right. Looking forward to hosting you in Chicago.
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This is Laura Dardo with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Namin Mahajan, president of Baylor Scott and White Grapevine. Namin, it's a pleasure to have you on the podcast today.
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A
Thank you for having me, Laura.
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B
Now, I'm excited to have our conversation because I know there's so much happening in healthcare today and particularly some really cool things you're doing at Baylor, Scott and White. But before we dive in, can you tell us a little bit more about yourself in the hospital? Sure.
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So Namin Mahajan, president of Baylor Scott and White Grapevine, been here a little over three and a half years. Background is been in healthcare. Gosh, it's been a long time now. So close to almost 20 years in in healthcare. And Baylor, Scott and White, we are the largest not for profit health system in Texas. We have over 1300 care sites, 57,000 employees, and we have a heavy concentration in north and central Texas. For our Grapevine location, we aim to serve our community, which basically goes all the way from Dallas to Fort Worth. It's about a million residents that are within our service area. And our goal and aim is to serve those residents and our community as that tertiary care facility so residents who live within our service area don't have to migrate to either downtown to receive world class healthcare.
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B
Absolutely. That's great to hear. You know, it's so important to have that care close to home and really make sure you're providing services to the community that are accessible and affordable. Now I'm curious, what can you tell us about the most important initiatives that you've led in the last year? What did you do and what were the results?
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Sure. You know, really nailing it down to one kind of becomes tough, but I think it's a, it's really bifold. One is really looking at our employee engagement and our team member turnover and then combining that with really, and I think this is a national issue over here is throughput and capacity management. So those were two big initiatives that we as a senior leadership team focused in on, on going into the last year of where we could really make an impact. And when we really dived into our data, the challenge that we had was really looking at first year turnover for our non licensed team members. In particular months we had exceeded 30% when you looked at historical turnover rates for that group of team members over there. Now obviously we don't lose any of our team members, but we really started diving in in collaboration with our hr, with our nursing team and other leaders of what was causing that turn over. And what we came to realize was it was really a scope of responsibility that when you looked at our nursing managers, for example, on a unit, not only did they have all the nurses, but now you have all the health unit coordinators, the patient care technicians, all of those individuals were rolling up to one leader and they really couldn't give them enough time and the support needed, especially within the first year, to really get their legs underneath them. And with healthcare being challenging and you know, units being full, that was an area we really dived into. So something that we did with that was smooth out our scope of responsibilities for not only our nursing managers, but our supervisors. And what this did was we put all of our non licensed personnel with the responsibility rolling up to the supervisor of the unit. So we saw a significant decrease in first year turnover. And secondly, as a byproduct of that, we also helped strengthen our bench strength for future leaders within the organization. Because another challenge that we looked at was supervisors really historically did not have personnel responsibility. So having personnel roll up to them, they've gotten used to, you know, looking at engagement, looking at team member career growth and development, disciplinary action. So this really does prepare our future bench strength and future leaders within the organization. Now you combine that with looking at throughput and capacity management. Did a lot of work with this and could not have done it without our hospitalist group and our hospitalist leadership. We started several initiatives here and I'll go through a couple of them and some of the results that we've had. So we've historically had multidisciplinary rounding. However, when we really dug into the data were those multidisciplinary rounds led by the physicians, really increasing our discharges before 10am noon, whatever benchmark you want to look at, and oftentimes we would miss on those. However, there was really never any follow up of why that patient was not able to discharge by a particular time. So what we started doing was adding a 2pm check back in of we thought patient X, Y and Z was going to leave this particular unit. And if they did not, what were the challenges and how do we mitigate that and hopefully in the future combat that so that doesn't become a challenge. And this is not only led by physicians, but we have our entire gamut all the way from imaging services, lab services, services, nursing team members, case management. As part of these calls, really digging into that, we have significantly been able to increase our percentage of patients that are discharged before noon over here and then on the weekends. What we realized was, you know, it was much harder to get everyone physically into the building, so we added a virtual option, and that also has been successful of increasing the number of patients that are actually discharging on the weekends. The other initiative that we put into place, which I would highly recommend that all leaders really look into, is a discharge, and we call it a hospitality suite. So if your care plan has been complete and you are ready for discharge, however, your ride is not available or another thing is precluding you from leaving the building, we actually can get you out of a patient room into a nice area with lounge chairs, TVs, et cetera, where you can wait for your ride. In addition, what we did with this is actually all of our discharge paperwork is completed downstairs in this hospitality suite. When you look historically and nationally at one of the big challenges we face as a healthcare industry is discharge instructions. Does a patient really understand how to maintain their health outside of the hospital so they don't have to come back into a hospital in terms of a readmission or staying healthy outside? So with medication reconciliation, discharge education, all of this is done by the nurse in the discharge hospitality suite. And when you look at patient experience between the overall group and the patients that discharge through this hospitality suite, there is a marked increase in patient experience scores when you look at the domain of discharge instructions over here. So we are keeping our patients healthier, getting them out of their patient room sooner. And typically, when we measure how long does a patient stay in this hospitality suite, it is under an hour. So, you know, it's a great win all the way across the board over here.
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B
That's amazing to hear and, you know, really cool to have that opportunity not only to continue to build up your bench of talent and leadership and engage employees in a more meaningful way, but also having that kind of match with some of the capacity management as you've been talking about, figuring out how to make sure you're moving patients through and giving the right instructions, as well as processes to understand when things don't exactly go as planned, how you can continue to Work and improve that in the future. I think that's so critical because oftentimes when I'm talking to executives, that capacity management, as you said, really comes up as something that not only is a challenge right now, but many anticipate will continue to be challenging in the future, given demographic shifts and other factors happening in the healthcare space. Just really looking for ways to make sure that the entire hospital organization is running efficiently so that you can continue to serve patients who need that inpatient care and operate at the right capacity.
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Absolutely.
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B
Now, when you're looking ahead, what are some of the big priorities and headwinds that you're focused on for 20, 26 and beyond?
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Sure. So I don't know if I'd exactly call this a headwind, but what we do see, you know, Texas is one of the fastest growing states in America, economy is strong, and the DFW metroplex, we continue to see an in migration over here. So our challenge really is our service area and our patient population continues to grow. And while we are blessed to have a well capitalized organization, beds take time to build. You know, even if we say today I need X number of new beds, it's going to take a multi year process to get those beds operational and up and running over here. So I think capacity management really is going to be a challenge for us universally in healthcare. And as you said, it really goes into resource management and how do you ensure that you're providing the highest level of care for our community in the most expeditious and cost effective manner possible. So I think that is going to be a challenge. But really where this comes into, and when you look at us in a competitive health care space, how do you win the preference of both physicians and patients? Because you need both in order to have a successful organization. So from a patient perspective, what we really challenge our physicians with is a commit to sit program. And this actually came from a personal experience of mine. We have a two and a half year old daughter and about six months ago overnight she developed this rash all over her body and so we brought her to our emergency room over here. And obviously my wife and mom was very, very nervous, scared, etc. And me being in the healthcare thing, tried to play it off cool. But obviously I'm also nervous and scared about what's happening to my child. And the biggest difference, what really calmed me down and set this from a patient's perspective was when the physician actually sat on the sofa next to my wife, walked her through what exactly was going on with our Child. And that demeanor and that approach calmed the whole situation down. So from a personal experience, brought that back to the team. We'd been talking about this for a while, but really honed in of how much of a difference that can make. And so we have made a concerted effort that in every patient room, we have a chair that the physicians, as they come into the room, will utilize and sit at the head of the bed with the patient. And many studies have shown, and we have actually seen it in our patient experience scores, when the physician sits at the head of the bed and has a conversation with the patient, their perception, even though the time spent is the same, is that the doctor was much more attentive. Dr. Communication scores go up. Dr. Listens to me, goes up. And it is a much more calming environment over here. So, you know, that is a program that we launched about four months ago. Been very, very successful in the initial steps. In fact, our physicians are saying that they're actually utilizing this. And even some of our naysayers at the early onset have really bought into this because they can feel the presence too. It is a much more meaningful conversation that they're having with the patients at the sitting level instead of just standing at the foot of the bed. And the patients definitely feel that, too. Now, the second component to that really goes into operations of how do you win the preferences of physicians? 90% of our specialists that utilize our hospitals are independent providers that have a choice of many different organizations that they can go to. And how we have decided to win the preference of physicians is, you know, this is a saying that I often share with our senior leaders. The only currency that I have with physicians that are independent is efficiency and time back at the end of the day that if they choose to operate here at our hospital, are their cases starting on time? Do we have the right preference sheets? Is all the equipment up, running, functional that they can have a smooth experience? Are we flipping ors over here? Is anesthesia a great partner with us and really helping to run the boards over here to make us the most efficient organization. And this goes all the way to our units over there. Anytime we onboard a new physician, we actually bring them up to the units and we encourage them to do a lunch and learn with the particular unit that they will be admitting their patients on. So our nursing team can understand the preferences of the physician, especially with surgical specialties and neurosurgery, orthopedics, et cetera, of do we understand a physician's protocols and oftentimes what this will do. When we understand their preferences of how their, how they would like their patients treated and their care plan, we can avoid those unnecessary phone calls. So if we operate, a highly efficient procedural area can get physicians out earlier, or they can add in a couple more add on cases when they look to book their next case tomorrow, where are they going to choose to book their cases? So those are two opportunities that we have really delved deeply into and are committed as non negotiables for our organization.
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B
Well, that's really impressive to hear about, especially you know, thinking through the patient experience and that coming from your own personal experience and then being able to accelerate and bring that to every single patient room that you have is so critical to that really overall care journey. And then, you know, thinking through the provider side as well. It seems like it's so critical these days to have that type of speed and agility when you're thinking about, you know, bringing in physicians and making sure that you're the facility of choice for them. So in kind of standing up this program and you know, physician preferences and how you can partner with them in a strong way, was it pretty simple? Was there anything that you had to do? You know, I guess for others who are maybe trying to think about the same thing that, you know, was really surprising or energizing for the team when you're standing up a program like this.
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A
You know, I wish that there was a single magic bullet that, you know, we could make healthcare much more efficient and agile for everyone out there. But it really comes into your day to day blocking and tackling. One thing I would recommend to all leaders out there is, you know, while we do have formal medical staff leadership positions, medical executive committee, etc. It is important to know your constituents. And something that I like to do is have a physician advisory group. And these are more informal leaders, but they're the thought leaders out in the, in the community and with their peer group over there. So as we look at strategic planning, capital deployment, house based physician groups, these are the key physician leaders that I bring in along with our senior, other senior leaders to really help drive the buy in and have their voice on the table too. Because when you have a very engaged medical staff and they feel part of the process, you know, we take pride in saying this is our hospital, I use my hospital. Our physicians utilize their hospital when they or their loved ones need care. And when you have that personal stake into the organization that you work for, you take a lot of pride. And we want the very best for our community and also for ourselves as members of our community over here. So I would highly encourage openness, transparency and really bringing in key medical staff members as part of that senior leadership team and thought leaders because sitting in the doctor's lounge, they will be either your biggest advocate or your biggest naysayer. So that would be my one piece.
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B
Of advice that is so, so helpful to know. Thank you for digging a little bit deeper there. Now I know there's a lot of great things happening, but you know, the future is certainly a lot of uncertainties there too. So what do you think is the hardest thing you'll have to do in.
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The coming year for us and I think for most healthcare leaders is how do you have that best value proposition for your community and your various stakeholders out there when you look at cost based healthcare, you know, we have ambulatory surgery sites, we have urgent cares, primary care. So how does an acute care hospital still stay relevant? And I think what differentiates us and where the value proposition comes in is that when I refer us back to our, my first comment is serving that community, serving our community as a tertiary care facility. And you know, this is not a easy overnight button, but we serve our community, the million people that live within our 20 cities that we serve as our area's only trauma level 2 center. We are comprehensive stroke certified. We have a top 100 ED in the nation, sees about 55,000 ED visits a year, level 3 NICU, level 3 maternal designation and our cath lab, when you look at door to balloon time, performs in the top 5% nationally. I think having those key very high acuity services, it has led to a great partnership with our EMS providers. In fact, over 75% of our total admissions come through our emergency room. So it truly functions as our front door of the hospital. Every month we deliver about 200 babies to our community and you know, those and being out there with those high acuity services, providing high quality care and high quality outcomes. The word of mouth from our community, our team members, we really take pride in the area that we work in. Anytime our community knows and I'm out there in the community educating as well, here are all the services that we offer here locally and really utilizing our EMS partners to be the biggest advocates for us out there. I think, you know, looking forward, maintaining those relationships, deepening those relationships, it is going to be our path to success.
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B
That's really great to hear and certainly, you know a lot out there. As you mentioned, thinking through that value proposition and having the right staff in place and team and then understanding you know, the ways that health care is changing is certainly, certainly helpful. Before we wrap up here, I'm curious, where do you see the best opportunities for growth across the hospital health system?
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I think this is, it truly is market and community specific. It is really understanding your demographic and the community that you serve. And I think that can only come from being, you know, heavily integrated into the community, finding where are those disparate needs for each community that you serve. You know, part of our vision and values for Baylor Scott White is empowering you to live well. And this really speaks to the heart of where we are in healthcare. And that doesn't mean, yes, absolutely, we will be here for those high acuity needs. But being a partner to the community of empowering them to live well outside of the hospital, technology AI our app over here. You know, I'll give you one example. And we call these patient journeys. And the patient journey doesn't start when the, when, when they present themselves to the, to the hospital. It is, the patient journey starts. How do you keep a patient healthy? So for a mom that just delivered a baby, we actually offer as part of our healthcare continuum through our app, for six months post delivery, they have ability to, two o' clock in the morning, your baby is screaming, you don't know what to do. You can actually access a virtual nurse and go through the symptoms of what your baby is experiencing and they can provide guidance of, is this normal? Do you need to go to an emergency room? Can this wait for your pediatrician in the morning? And, you know, offering those services to the community. Healthcare has become much more consumer centric now. And when, if Amazon knows that you're running, you know, short on dog food and your next dog food delivery shows up at your doorstep without you even having to think about that, how do we as healthcare become that integral into the lives of the community that we serve? So it's not only there for the acute times that you need, but we are truly a healthcare partner for your entire continuum and your and your journey to live well.
- [21:03]
B
I love that. That's such an amazing philosophy and, you know, really, truly thinks about the patient and has them at the center of what the care can and should be. Thank you so much, Namin, for joining us on the podcast today. This has been a really, really fun conversation. I look forward to connecting with you again soon. You know, seeing you in April, I know you'll be speaking at our annual meeting, which will be such a fun gathering in terms of so many different leaders from across the country talking about how they're thinking about challenges as well as some of the great programs and initiatives that they're working on. So I'm sure we'll continue this conversation and looking forward to seeing you next year.
- [21:39]
A
Absolutely. It's been a pleasure. Laura, thank you so much for your time.