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A Special Edition Q&A with Dr. Rachel Thompson — Issue #12

A conversation with Core’s new President of Clinical Services about leadership and the future of the industry

Greetings from Atlanta everyone!

I’ve been sending these newsletters once a quarter, but so much has happened lately here at Core that we’ve decided to make an exception (also, we’re a flexible company!). Here are just a few of the major recent announcements:

  • Core was named to Inc’s 5000 list, and was the 6th-fastest growing healthcare company in the country (and the 40th fastest growing company overall).
    We announced a new partnership to manage three EDs for OakBend Medical Center in Houston. Core now manages 27 emergency medicine and hospital medicine programs in 7 states.
    And, among many new leadership hires, we announced that Dr. Rachel Thompson, a national leader in hospital medicine, has joined the team as President of Clinical Services.

We had already worked with Rachel on an interim basis—she was instrumental in helping Core during the startup of a system-wide hospitalist medicine program that sees 180,000 patients per year spread over seven facilities.

When she walked into that situation, no one knew her personally or had any reason to expect she’d be able to solve every problem. Yet by the time she walked out, Rachel had earned the respect of everyone in every part of the system, from the c-suite to clinical leaders at other groups, to our own doctors, nurses, and managers.

Simply put, Rachel is an outstanding leader and change agent. That’s why we wanted to sit down with her and level-set about the current state of healthcare, the future of hospitalist medicine, and what good leaders can add to the most pressing problems in acute care.

Now, here’s our Q&A with Dr. Rachel Thompson:

Hospital Medicine has evolved since its inception 25 years ago. What changes do you think will happen within the specialty in the next 5 years?

The next five years are going to be challenging for hospital medicine and hospitals in general.

One of the biggest issues today is that patients are waiting to get into hospitals and can’t because there are patients who can’t get out. The problem is mostly due to our social infrastructure and payment models for recovery care. Following an acute hospitalization, there often isn’t enough money or even a place to go, and so patients end up staying in the hospital. Along with the closure of many hospitals, which is consolidating care to the remaining, we are facing a crisis of availability for acute care.

We have to solve the problem of how to get people out of hospitals. And we have to be innovative about how to do it. One innovation, Hospital at Home, is beginning to mature in certain places, and it has a lot of promise for admission avoidance. We have to figure out what is the right patient population to safely care for at home, work collaboratively and get the technology in place to grow those programs.

But then, if you take the subset of people with the lowest acuity and move them home, the acuity in the hospital will further increase. We have already seen this. Fifty years ago, you could spend a month in a hospital for pneumonia. Now, we send you home with a pill. Now, we are getting to the point where we’ll continue to see high acuity and reduced availability of resources.

So, there are huge challenges ahead of us, and we need good leaders who are capable of doing the kind of collaborative work needed to meet those challenges.

What do healthcare leaders need to do to meet those challenges?

Leaders need a solid foundation of skills and practices. We must build ourselves into leaders who bring people together and move toward common goals.

Leadership training is key for us all—and it can and it should be a daily practice. It is not a part of our medical training—but it should be. Leadership training could just as easily be called Humanism Training. For the individual, it means working on three practices daily: patience, active listening, and empathy.

Why are these practices important? Because these are the skills we need every time we navigate challenging conversations and negotiations that we encounter in the acute care setting, whether that’s me and another person, or me on behalf of my team, or with a system, or another group.

We need to get away from the situation where we are fighting for x, y, and z, or me vs. you, and instead begin to understand each other and each other’s needs. With these skills, one can best understand the landscape, their colleagues, the situation, and the needs. This understanding is what leads to true collaborative change—the type of change that will actually shape and improve our future.

What role does leadership training play when all the incentives in healthcare seem so misaligned?

Good leaders can make a huge difference if they can properly deliver to people the why.

It is true that incentives are mal-aligned. The payment structure rewards just do more. It hasn’t just created a monster—it’s created millions of monsters.

As a country, we’ve driven ourselves into this corner, and medicine is in this place where we need to grapple with whether it will be bottom-line driven, or if healthcare is a basic right for all humans.

Either way, it is not enough to say, “we do this for the patients.” One must deliver a why that is specific to the what. A why that makes sense to patient care and a why that makes sense to the health system.

Some hospital medicine groups have become clinician-centric in the sense that they frequently ask for or demand benefits for the group. Programs that can flip that mentality have the best success. A key to doing this is identifying and chasing goals that they have in common with the health system. Instead of coming to the table demanding things, we come to the table demonstrating our value to the system.

Once refocused on the why, we can approach negotiations differently. We create a setting where people understand that we are key to the success of the whole organism. Then through that, if we need something for the group, it makes much more sense to all.

Can you give us an example of how that discussion would play out in a hospital medicine setting?

Take, for example, implementing a geographic rounding program.

Let’s say the physicians question why they should only see patients in one unit. They don’t think it’s better for the patient. They worry that if a patient is transferred to a new unit during their stay, then the patient gets a new physician. They fear this disrupts continuity of care, affecting both the physicians’ workload and the patient experience.

Here, the physicians do not yet understand or buy into the why. For geographic rounding, the why is the efficiencies gained through building interconnected teams. It’s being able to communicate the plans and coordinate across disciplines for everyone who is supporting the patient’s journey and trajectory of care. It dismantles the old notion that the physician leads the charge, pushing the care, dictating “do this,” “do that.”

Instead, geographic rounding allows for multidisciplinary care, and a patient’s needs are better met. At the hub is the nurse at the bedside driving care and who is doing most of the work day-to-day for the patient. There likely is a physical therapist, maybe a pharmacist, a care manager, and a social worker too. Consultants may also be in the mix. The hospitalist has to get into the space where they quarterback communication among all of these disciplines—if they don’t, everything slows down and the chance of mistakes goes way up.

And, if you still don’t buy into this why, I guarantee if you’re in a geographic rounding model, you will get fewer phone calls, you’ll get interrupted less, you’ll get your work done faster, and you’ll be happier.

Is there a particular model of care that is best at delivering that kind of collaborative environment that drives good outcomes and efficiency?

There’s no one perfect model in existence.

But, there are elements of it out there. Probably the system best known for taking a truly multidisciplinary approach is Mayo Clinic. They’ve just done that in a very systematic way, where they have teams of clinicians looking at things together. But that’s in the outpatient setting. Intermountain Healthcare in Utah is making strides in the acute setting. And Virginia Mason in Seattle, where I live, has done a very good job of bringing in LEAN principles for process improvement.

But no, there is no one-size-fits-all, no perfect model out there. Right now we can see parts of it in different systems, but each system is unique. The approach is similar in every setting, but the solutions vary. What we need is to get everyone on the same page, including the hospital c-suite, our clinical teams, and operational leaders, and to collaborate to figure out what are the challenges and the solutions with this specific population, at this specific site.

Hospitals are struggling to make ends meet—where do you think they can find ways to save on cost in the coming years?

If I had that answer I’d probably have too much work! In all seriousness, I think and I know we can work smarter. In acute care, we’ve become bloated in our ways of doing things. We need to be more efficient.

But it’s really hard for big systems to take deep looks and actually become efficient. That said, in the places where we have success, we do see cost savings, and we do see that we can work smarter. We can work LEANer. There is potential, but it’s hard work to do, and hard work in big, complex organizations with high acuity where there are a lot of distractions flaring on a daily basis.

Ultimately, I think the goal is to come together as a healthcare community. Administrators, providers, and all the ancillary groups. We really do have to become more interdependent and less antagonistic to improve for our future. To build that next-gen hospital, we all have to understand that to provide high-quality care to that high acuity patient, we’re going to have to be in lockstep.

That’s why we need good leaders. And we need to develop them, train them, and deploy them consistently across the entire system.

Finally: what drew you to Core Clinical Partners? Why did you decide to make it the next step in your career?

I was drawn to Core because everyone here is interested in true, ongoing improvement.

And this is reflected in the infrastructure we set up at sites—one that is ready to do that improvement, to look carefully at the environment, and to think, “What are the options to navigate through administration and clinical services? How can we ensure that collaboration happens not just now, but on an ongoing basis into the future?”

This degree of partnership and presence as a physician services company is uncommon. It’s part of our brand, and what we believe in, but also it’s something we’re more agile about and just better able to do. Other groups say they do it, but we deliver.