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Becker’s Healthcare Podcast
Todd Smith, MD, Chief Physician Executive at Sutter Medical Center
00:17:53
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- [00:02]
A
@ Athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams, and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom Practicing medicine is complex, but running a practice can be that Much simpler with Athenahealth. See how simpler is healthier at athenahealth.com.
- [00:45]
B
Hi everyone, and thank you so much for tuning in to this episode of the Becker's Healthcare Podcast. I'm Erica Carbajal, an editor with Becker's Hospital Review, and today I'm joined by Dr. Todd Smith Smith, senior Vice president and Chief Physician Executive at Sutter Health in California. We're going to be discussing his top priorities through the end of the year, ambulatory growth strategy and clinical standardization. Dr. Smith, thank you so much for being on today. Happy to have you.
- [01:16]
C
Thank you for having me.
- [01:18]
B
Yeah. Well, as we enter the final stretch of the year here, can you start by telling us a little bit about what your top clinical or operational priorities are? What what are you personally spending the most energy on right now at Sutter?
- [01:34]
C
Well, thank you, Erica. As probably mentioned in previous podcasts as well, we have been really growing our physician and clinician base significantly over the past, really two years or so, adding over 1500 to 2000 new clinicians. And so once you hire them now, you need to actually get them onboarded operationally enough to speed up. At the same time, we have been expanding our ambulatory presence. So one of the biggest issues that we've run into is obviously access to healthcare, which is a national issue. We have the same problem as well. So the two big things that we've been focused on over the past really 18 months or better is really improving our ambulatory footprint and improving and increasing our physician and clinician base. The 2025 we've opened approximately 17ambulatory sites so far, and we have another probably five or six to go. And so most of my time right now has been spent around how do we get these new sites open, how do we make sure they're staffed appropriately, how do we make sure we've onboarded all the clinicians and the staff so that we can provide that access the patients are really needing from that standpoint and focusing on providing that access and that experience, as we're sort of moving into the Last half of 25, to try to create a better place, not only for the patient to receive care, but also for the clinicians to work. And so the other part of my day is spent really thinking about and supporting our clinicians. And what does that look like to practice at Sutter Health with the advent of new clinical technologies, with the advent of some of the support structures we have as we move forward? So a lot of work really around that, that clinical base to try and improve our access and experience for the patients.
- [03:27]
B
Yeah, thanks, Dr. Smith. And I know you mentioned just the onboarding piece, and obviously onboarding 2000, no physicians in only a couple of years is no small feat. And I think onboarding continues to come up in conversations with physician leaders as a challenge of sorts right now. So can you expand a little bit just on how the onboarding piece is structured and organized across the system and who is really in charge of having that process be streamlined and organized?
- [04:01]
C
It's a great question, Erica, because as you can imagine, with eight different medical groups across 26 counties in northern California, you can imagine that there's a lot of variation that can occur in that process. So what we've really been trying to do is each of the medical groups partners with our physician services services and our operations people to create an onboarding process that. That begins well before they actually start with, you know, creating their accounts and creating their schedules and opening them up and trying to create that sort of welcoming feeling for when they actually start. It's still a work in progress. I would. I would not say it's done. I think onboarding is a journey, and it doesn't. It doesn't start the day they start. It doesn't stop the day they start. And so part of that process is creating something that makes them feel welcome in the organization, something that helps them to understand it. So there are orientations for the physicians themselves and the clinicians with the medical group, so they understand what it means to be part of the medical group. There's another orientation piece which is actually part of the system, so they understand what it means to be part of the system. And we partner with the medical groups to provide that and then orienting them to the clinic they're going to be working in and the people they're going to be working with and how do we support that particular piece. So it's an ongoing process that is jointly owned by the medical groups themselves, who are the hiring entity here in California as well as our foundation counterparts to provide that support for them.
- [05:34]
B
Yeah. Thanks, Dr. Smith. Well, I know you mentioned ambulatory expansion and in access there as well. I know Sutter is in the middle of a $1 billion expansion there. So with rapid ambulatory growth, how are you ensuring clinical integration and continuity of care across sites? What sorts of measures or practices are you putting in place to try to maintain that care quality as more services start to shift outside of the hospital walls?
- [06:03]
C
It's a great question because you're right. There is this steady but constant shift of things from the acute session to the ambulatory session. So one of the biggest things that we've done over the past couple of years is to really create an operating rhythm which creates a way of communicating both at the individual clinic level, the facility level, the division level, which encompasses both foundation and hospital based, and then the system level and creating that in such a way that there's a clarity of conversation and a clarity of metrics that we are going to actually be looking at as we move forward. And those are some of the standard metrics around quality, around whether they're in the ambulatory world, around your infection rates and around things of that nature. You've got the acute ones as well. But one of the pieces that as I was talking to one of my quality directors about this the other day, what we're learning is the onboarding in the ambulatory environment. We've got to be very careful about that because typically in the acute environment, you've got nurses training nurses. And so there is a definite procedural bend that you understand that as you get into the ambulatory environment, you may not have that like training like in the process. And so making sure that we've onboarded our people in the clinic setting to understand what it means to do some of these procedures in that particular arena. It's a different skill set for them. And it is something that we're realizing and we are actually implementing as we move forward from that picker piece.
- [07:38]
B
Yeah, that's a great point. Thanks, Dr. Smith. I think too, one of the things that as we continue to cover more and hear about healthcare's ambulatory boom, if you will, and the shift of that care, just questions and implications of what it might mean for care in inpatient settings. So as this trend does accelerate, what considerations does it raise for hospital leaders? What are you thinking about, especially in terms of staffing or care model changes to ensure that inpatient teams are equipped for a new, new reality in the years ahead in terms of patient acuity.
- [08:21]
C
I think it's a good point because we are beginning to see changes in our case mix index in the inpatient world, implying that we are treating sicker patients in the process. And part of that is the recognition of how do we actually provide our teams with the capabilities, capacities to provide that care in a safe, effective and consistent manner. Some of that is going to be ensuring that we've got regular training for them. Some of it is going to be how do we leverage technology, how do we actually employ technology so that individuals can be doing things that only individuals can do? And you can utilize some of the technology to help give you information that you might not have had at your fingertips. So things like some of the predictive modeling that we are beginning to start to see in some of the environments around who might be deteriorating a little bit faster than you actually think they are. So instead of the teams responding once the crisis occ, which obviously is less efficient and not as good for the patient, how do we sort of incorporate some of that information a little earlier such that we can identify these people? This is emerging technologies in certain places, but certainly something that we're keeping our eye on. We're looking at, we're incorporating in such a way as to really equip our people with what they need. Other ways are understanding, if you think about observation or sitting or patient or sitters that need to observe patients, really can we employ, and have we employed electronic or visual virtual means of sitting so that way you can free up the individual from doing this, you can provide more real time information and allow the nurses and the aides to be more attentive from that standpoint. So really trying to help them from a care model standpoint and give them the information when they need at the time they need it to be able to actually do their jobs better in a safer manner for, for them and the patients.
- [10:23]
B
Yeah, definitely will be interesting too to see with the predictive modeling and what that might look like, you know, just a few years down the line. I want to talk now about care standardization. I think it comes up increasingly not just as a way to improve care outcomes, of course, but also as a way to improve operational efficiency, is something we hear a lot about nowadays. So I think it's also one of those things across a large system, like many things in healthcare, that might sound simple on the surface, but is incredibly tough to execute is what I hear, particularly when you think about the nuances in local settings and clinical autonomy of clinicians. So can you tell us a Little bit about Sutter's approach here. What has the system done to try to make clinical standardization and evidence based pathways work in practice? And are there any lessons that have emerged about making this work at scale?
- [11:23]
C
That's great insight, Erica. One of the things that we have learned is scale is helpful at times and other times actually can get in the way. One of the pieces that we have been working with over time is exactly what you talked about, which is identifying those clinical best practices in such a way that they can be available and they can be spread and adopted across the organization. We've learned that it requires clinician leadership and involvement in development of those particular pathways, both at the local level as well as at the system level. And then we've learned that there's a communication that has to take place on a very consistent basis so that there is the ability to learn. At the end of the day, being a learning organization allows you to adopt the technologies, adopt the pathways and then iterate and improve them as they actually go. And one of the things, things that we've learned is we, we put an operating calendar into place that I talked about before, which was that, you know, part of it is the local part of its daily, weekly and monthly check ins. But the other thing that we've actually started to do quite a bit now is we're celebrating successes. So we'll, we will have system level meetings where we'll actually celebrate best practices, whether they're around infection prevention, whether they're around length of stay reductions, whether they're around discharge lounges, whether they're around improvements in throughputs in operating rooms or in emergency rooms. And what we're doing is we're highlighting the work that's being done in various places in the organization. And then we've also developed, in a couple of places, we've developed the ability to send teams out to other places that are actually having challenges so that we can accelerate that sharing of best practices and measuring to the same outputs as we continue to kind of go, go down this road. So it is a, it is a journey, it is one that's never ending, but it is one that we believe that we can actually accelerate that if we shine a light on the work that's being done in those places. Are doing it well.
- [13:35]
B
Yeah, great point about sharing out those, those best practices. Well, lastly here just want to talk about the chief physician, chief medical Officer role. How do you see that role evolving in the next two to five years? Let's say, what new skills or leadership qualities do you think will define the most successful CMOs of the future?
- [13:59]
C
That's a great question because I just have to look back two years because I've been in this role about two, two and a half years at this point, and just the skill sets I've had to develop at this point to be successful. I think one of the things that is true is as you talk to chief physician executives, they are, there's a wider breadth of what we're responsible for now than the standard chief medical officer was. Most of the chief medical officers were responsible for just pretty much the quality, the clinical transformation throughput in interacting with the medical staffs, both the ambulatory as well as the acute. As we move forward, you notice that at the outset, what were we really working around? The operations pieces. I'm much more involved in the operational day to day pieces as far as, you know, what drives the clinic referrals, what drives the clinic throughput, what does our staffing model actually look like in the hospital? How does our emergency room throughput actually work? How is the operating room actually? What's our supply chain cost look like? When we've had challenges across the country around the IV fluid issues, we found that we were involved in what that looked like and that was a very operational issue. So I think that as, as we move forward and then as we begin to think about what does hiring look like, what does acquisition of other organizations look like, how do we integrate systems into ours, and having a medical viewpoint around an operational issue and being at the table for that, I think that's actually different than it was two or three years ago. I expect to see that continue. So I expect to see the successful chief physician executive be well grounded in all the clinical pieces, be well grounded in the quality pieces, but also becoming much more well versed in the operational pieces. So they can be a thought partner with. In my case, I'm a thought partner with the chief operating officer for the system. And I think that's a different skill set than many physician leaders have had over the years.
- [16:24]
B
Yeah, absolutely. I think it's a theme I've heard in a few recent conversations as well. Well, Dr. Smith, thank you so much for taking the time to join the podcast today. It's a pleasure having you on talking about a lot of relevant topics that come up in so often in conversations with clinical leaders. And hopefully we foster some peer learnings here and hope to welcome you back to the podcast again soon.
- [16:53]
C
Very good. Thank you for having me today.
- [16:55]
B
Yeah, thanks so much. Take care.
- [16:59]
A
At Athenahealth we know your ambulatory practice wants healthier a healthier business, healthier care teams, and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom lines. Practicing medicine is complex, but running a practice can be that much simpler with Athenahealth. See how simpler is healthier@athenahealth.com Sam.