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Becker’s Healthcare Podcast
Standardizing Care and Expanding Specialty Services at Cleveland Clinic Martin Health
00:19:24
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- [00:00]
A
Hi, everyone. You're listening to the Becker's Healthcare Podcast. I'm Erica Carbajal with the Becker's Hospital review team. For today's episode, we're joined by Dr. Chirag Choudhary, Vice President and Chief Medical Officer of Cleveland Clinic Martin Health. Dr. Choudhary, thank you so much. Welcome to the podcast.
- [00:21]
B
Thank you for having me. I'm delighted.
- [00:23]
A
Yeah. Well, to start us off, what is the single most important goal that you'd point to that you're focused on in your first year as CMO of Cleveland Clinic Martin Health? I know you joined recently.
- [00:36]
B
Yeah, absolutely. So just a little bit of background. Cleveland Clinic Martin Health is a three hospital system that includes Cleveland Clinic Martin North, Martin south, and Cleveland Clinic Tradition Hospital. I was lucky enough to serve in the role of Vice president, Chief Medical Officer of Cleveland Clinic Tradition, and now in this expanded role over all three hospitals within the Martin Health System, what that allowed me to do is one, get a good understanding of how the hospitals are functioning and how they're interconnected with each other. Because at the end of the day, what we want to provide is a strong foundation of clinical care. We want to be able to deliver this consistently, reliably across both counties that we serve, which is Martin county and St. Lucie County. Now, what does that mean for somebody who does not work in medicine, who might listen to this? What that means is if someone comes in as a patient where it doesn't matter as to which facility that they walk into, whether it's the hospital, whether it's one of our outpatient sites, that they experience the same safe, timely, and coordinated care every single time, what do you want them to. That experience needs to be absolutely standard, irrespective whether it's outpatient, inpatient, and it doesn't matter as to which site they interact with us. Looking into how do we go about making this happen, and everything starts with data. We look at our capacity, we see as to how we're using it, quality and safety outcomes across the board, and then what our communities are asking of us, whether it's the hospitals or the ambulatory sites, where is the demand, which services do the patients need, and if there is any variation in the care that we are providing across these sites, and how do we meet those needs. After starting with data, our next piece is working with our team of teams. It's our physician leaders, it's our nursing leaders, our operations leaders, both on the inpatient side and the ambulatory teams, really coming up with some concrete priorities, things like Standardizing our key clinical pathways, making sure access is streamlined, and then sequencing what our capital and program investments are going to be so that we're not just reacting to the current volume and the current demand, but what does a community need right now and what will it need for the next 5, 10, 15, 20 years into the future? So we've started with data, we've got our teams together, we have a plan. We execute on the capital plan, be able to meet the needs, and then it comes the next step. How are we doing with our plan? And a few early markers of that are really around targeted quality metrics. Were we able to onboard the new specialists and the new primary care doctors that we wanted to start at these sites? And how are we coordinating? Because, you know, care is getting more and more complex, especially in the state of Florida where Cleveland Clinic Martin Health is. We have an older patient population, people with very complex needs. How are we being able to meet these complex care requirements not just at that one site of interaction at one of our ambulatory sites, but being able to make sure that these patients are able to not only meet their primary care needs, but any of their consultative needs at any of our other ambulatory locations or if testing needs to happen on the inpatient side. So overall, I would say looking back at this first year of serving in this role over the three hospitals, I think we have really raised the bar when it comes to reliability. We have planned for some very thoughtful growth and made real progress.
- [04:55]
A
Yeah, thanks for sharing that. I think it's always interesting to hear just about the theme of consistency in the care experience and care delivery and so much that goes into that in terms of clinician alignment and analyzing the data. So much strategy and planning. So interesting to hear about. Thank you for sharing. I know you mentioned your previous role as CMO at Tradition Hospital and there I know you helped expand key programs like the Comprehensive Stroke center and helped recruit specialists to strengthen cardiovascular and specialty services. One of the things that we hear a lot about is the competition for specialists, especially subspecialists. So as that intensifies nationwide, what strategies have you found most effective in attracting and retaining the talent that is actually needed to build and sustain those types of programs.
- [05:47]
B
Programs, absolutely. That's a, That's a great question and very timely to. If I was to look back at my week this week, we have. I've sat down and interviewed two possible cardiologists that we would like to. To join our team. And before I ask them to, you know, you know, we looked at the CVs before I asked them, like, please tell me about yourself. The first question I said, what do you want to know from me? Every single time the question is, well, what is your vision? That is where I feel like, what separates us? And being able to recruit the top talent that we need is being able to articulate as to what a community needs, where the demand is growing, how they're going to come help not only expand the program, but really build the program and be able to take it to the next level. It doesn't really matter whether it's cardiovascular care, stroke care, or any other complex service. It's not simply filling a vacancy. That role is far more compelling for the physician when they can see how they're contributing. And it also ensures that we're doing the right thing for the communities that we serve. And at the same time, recruitment is fundamentally relational. We want to get to know as to what their professional goals are, what the family needs, what kind of culture are they looking for? And does that align with Martin Health and Cleveland Clinic? Because we want them to come, we want them to stay, we want them to be happy, their families to be happy, because that's the only way we're going to be able to deliver on our commitment to quality and safety. In addition to that, what allows us to be able to really recruit this top talent is just the breadth and the scope of Cleveland Clinic, because it allows people's careers to evolve. There are different leadership opportunities, whether it might come in academia, research, publishing on an operational end, and getting involved in any quality program. So it allows people to evolve not only as clinicians, but the person as a whole, and really add to
- [08:28]
A
what
- [08:29]
B
they're looking for, depending on whichever chapter that they are in their lives. Another place that gets overlooked sometimes is when a new physician or a new surgeon starts. How do they feel when it comes to support? What I mean by support is, do they have the appropriate nursing support operationally? Are things working the way that they should? Our ambulatory teams making sure that the referral patterns are set up, the support staff is there, and that there is a good onboarding plan? We want our doctors and our clinicians to feel supported and productive from day one. We don't want someone to come and then try and spend the first six months trying to figure out how to navigate the system. I can give you another very concrete example. Focusing on the cardiology piece is we're recruiting cardiologists. We have recruited. We've really grown on neurology, neurosurgery, Neurointerventional program. It's not just to meet the broader growing cardiovascular and complex care demands of this region, but it's really making sure that when we are meeting these needs, we are also ensuring that our patients receive the most advanced care close to home. They never have to get into a car and have to drive to either Orlando or Miami to get this care, that we're going to be able to provide this care to them here at home, within their communities, locally, on the Treasure Coast. It's a very intentional program focused on finding the right cultural fit and having our physicians, our surgeons, our clinicians, our nurse practitioners, our peers, anyone who joins, really feel that their work is impactful and that we are committed to them.
- [10:26]
A
Yeah, Dr. Chaudhary, and I think you raise a great point too, that we don't often hear a ton about. Just when it comes to discussions around recruitment. Is that the piece of painting the picture for physicians and having them see their involvement in decision making and kind of the bigger picture and painting that for what that looks like for them and how valuable that that can be? I know earlier in our discussion you mentioned just demands for care growing and care becoming more complex. I think especially acute in Florida, where the state continues to see such population growth, especially among older adults. Can you expand a little bit on how Martin Health is thinking about which specialty services to expand locally versus when to leverage Cleveland Clinic's broader Florida or system wide network?
- [11:19]
B
Yeah, absolutely. I think this is what helps for us to be a part of a large global academic health system is needs that we can meet locally and then what we can lean on, on our worldwide expertise for specialties that we might may not have currently or have, and being able to make sure that our patients have access to them. So focusing on Florida, Florida in general and the Treasure coast in particular, specifically the St. Lucie county area, has really experienced some very rapid population growth. It has become incredibly popular during and post the COVID pandemic. And as you know, it's generally an older population, multiple chronic conditions, and the need to be able to provide complex care, I mean, care for complex clinical conditions in a very coordinated manner. First step for us, again, going back to the first question is around understanding data. Where are the people moving to which neighborhoods are growing? What conditions are, do people need the services for? And which services are patients currently having to travel to receive that we can meet these needs locally? After that, we ask ourselves two key questions. Where is it essential to build this local capacity so our patients can receive timely, high quality care? That's close to home. And where is it better for us to tap into the breadth of the Cleveland Clinic network, whether it's in Florida at Western or across the enterprise in Cleveland, Ohio for this highly specialized coronary services in some areas like emergency care, stroke care, cardiovascular services, medical services, general surgical services, we offer these robust local capabilities right here on the Treasure coast at traditional Martin north and Martin south. Which means investing in the right specialists, the right technology, the right care models, really leveraging our nurse practitioners, our physician assistants with the physicians and surgeons so that our patients don't face any delays when it comes to accessing care, especially in sensitive situations, and making sure that they stay connected with the local healthcare team and the local communities in other areas where it makes our sense to leverage our broader network. That's where we coordinate referrals, whether it is with our other Cleveland Clinic Florida location in Western. It could be in person or it could be through virtual consults with subspecialists and arranging seamless transfers for highly complex procedures where a patient might travel to have a specific complex procedure done at Western. But we can do all the pre and post care we want it to be like from the patient's perspective, their interaction with us. It should feel like one connected system. We share our protocols, we communicate freely, and as the end of it all, we always keeping the patient at the center of it. We wanted our ultimate goal is high quality care right here on the Treasure coast. Make it easy for our patients to access the full depth of the Cleveland Clinic expertise when they need it and without the burden of have of them having to navigate it all on their own.
- [15:29]
A
Yeah, absolutely. No, that makes a ton of sense. Dr. Choudhary, lastly, I just wanted to ask you about quality and safety. I know that will be a core part of your portfolio as CMO as well. So as you look across Martin Health's three hospitals and outpatient footprint, where do you see the biggest opportunities to strengthen that reliability in care delivery? And perhaps what specific metrics or initiatives will you be watching most closely?
- [15:57]
B
Absolutely high reliability. To me that means that our patients can count on us to deliver safe, effective and compassionate care every time. Not just most of the time, every time. It really starts with our Cleveland Clinic culture of making safety a non negotiable expectation. We make sure our caregivers feel safe to speak up about any concerns, any near misses, so that harm will not reach any of our patients in our care. It's across the board. We don't have a single meeting, whether it is any of our tiered huddles in the morning or an executive team meeting without talking about quality, patient safety and patient experience first. That remains first and foremost in our minds. And that's the first thing that we discuss before we step into any other issue that we're going to talk about. And as I look across our hospitals, our outpatient sites, I continue to, you know, we find opportunities to further standardize this care for high risk conditions and specifically around sepsis. Our hospital system, Cleveland Clinic, has partnered with different technology firms and in specific, our partnership with Bayesian for our sepsis detection algorithms, which means that we have it embedded in our clinical workflows in the hospital, helping our clinicians recognize when someone is at a high risk of developing sepsis so that we can respond to that sooner, we can start the diagnosis sooner, we can start treating them sooner. And the reason why that is important is for anyone who has developing sepsis and then developing septic shock, which means that they're having changes in their blood pressure or their mentation because of this overwhelming infection, for every hour that we can get that antibiotic earlier, every hour reduces their mortality by 7%. This is how we want to leverage artificial intelligence, really strengthen our clinical workflows and improve patient outcomes. At the end of it, what this does is it reduces variation and it helps our teams respond quickly and consistently to every single time.
- [18:41]
A
Yeah, Dr. Chaudhry and I love what you mentioned just about the culture and how important that is in quality and safety. I think it echoes a sentiment that we hear often lately, especially from clinical leaders, is just that a lot of teams can be good at quality and safety initiatives, but culture is truly what drives the day to day improvements and sustaining that focus.
- [19:06]
B
Absolutely. I could not agree more.
- [19:08]
A
Well, Dr. Choudhury, thank you so much for taking the time to join us on the podcast today and share your insights with.
- [19:16]
B
Oh, thank you for inviting me. It's really been a pleasure talking to you, Erica.
- [19:20]
A
Yeah, thanks again.