Mark Canada joined Core Clinical Partners as Vice President of Clinical Operations in March 2021. We sat down for a conversation about his past work for Envision, why he decided to join Core, and how the ability to be an agile partner in making clinical and operational improvements will serve Core’s hospital clients in today’s rapidly evolving healthcare environment.
You were with Envision for nearly six years — why’d you decide to move and join Core Clinical Partners?
I wasn’t actively looking for a change, but I saw that Core was creating a new role in clinical operations, and when I began talking with Dr. Robinson and the team I sensed that Core could be an agile force, an adaptable force, and that would mean I could really bring value on multiple levels to clients quickly. I think that flexibility is somewhat unique in the marketplace right now with the other models that are out there. At Core, I will be able to really dig into all the operational flows, the clinical flows, the value-based care initiatives that a site may have.
What experiences from Envision will you be bringing to your role at Core?
I started out as a nurse on the hospital side. I’d been a client of EmCare, as it was known at the time, and when a role as Director of Clinical Services opened up, it seemed like an attractive opportunity to really drive clinical quality and care at multiple hospitals. Eventually, I was promoted to Vice President of Clinical Services, managing multiple states and service lines and having multiple directors working for me.
I’m very proud of the work my teams did there, especially that I was able to mentor my team to win numerous quality awards for the work they did. They won awards for value-based care initiatives, demonstrating returns to multiple stakeholders. The patients received better care and a better patient experience, both the hospitals and payors had reduced cost, and clinicians were engaged. So, we hit the true quadruple aim.
Most recently we did this with sepsis care, where we were able to meet 100 percent of our sepsis core measures. I’ve also recently been a part of teams and led teams in their implementation of telehealth, both in the emergency department and on the inpatient side. We put a lot of processes in place to help with patients during COVID, from tele-triage in the ED to managing surges in patient acuity and providing virtual support to APPs at smaller, remote hospitals.
What do you think makes a clinical operations program successful, and what sets the quality ones apart?
Part of my role is to build effective teams within the hospital. The easy thing is to just drop a book on the table and say follow this. The hard thing is to take the time to really listen and discover what the unique barriers to change are within each particular hospital, and adapt a process change to the unique challenges of that facility.
My job is to work with the physician leadership and nursing leadership and hospital leadership to identify what those barriers are to delivering high-quality care and then to overcome those obstacles. There are multiple tools we use, from operational assessments and data analysis to resources drawn from Lean methodology and Six Sigma.
With Core, I’m able to go spend time with the client, being on site, literally walking through the process, marrying observational data with hard statistical data, and beginning to identify those barriers. Part of the value we bring is that our bandwidth is higher for each individual client, and we keep our client-to-clinical operations ratio low. So I’m able to focus more on fewer clients—I can spend multiple days a month with each one, and that may not be something you get with larger companies.
How do you make sure the process change within hospitals and departments is long-lasting?
Oftentimes what hospitals see is a successful process change implementation, with really good metrics for a few months, but then a regression afterward. This can happen for a lot of reasons. There can be turnover on the nursing side or hospital leadership side. It can be a change in focus at the hospital. The hospital can redirect its attention and take its foot off the gas too soon.
That’s the advantage that Core has in being able to have that stickier, long-term engagement, and give it continual focus over time. We can help clients build that culture over the long-term, and implement those positive feedback loops. It takes time, and it requires ongoing adaptation over time until it begins to be hardwired into the culture.
What is the current state of telemedicine—are hospitals looking for enterprise-wide solutions, or point solutions for specific use cases?
It depends on the site, depends on the hospital! We’ve all learned a lot about telehealth in the past year. It’s been an invaluable tool and will continue to be. At Envision I supported all kinds of implementations, both related to supporting the COVID response and in moving care outside the four walls of the hospital, through to patient follow-ups, in pediatric care settings, you name it.
Core is able to partner with healthcare providers to provide solutions and has the enterprise-wide bandwidth to do that, to be able to support multiple service lines at multiple hospitals, or we’re able to provide telehealth as a standalone small piece. There are multiple options and multiple ways to partner with our sites, and we have the agility to do that with targeted solutions, whether it’s resources on technology, resources on personnel, or with process improvements.
What can a group like Core clinical offer hospitals in terms of clinical operations that other EM or Hospitalist providers can’t?
We bring a consistent, routine, and engaged partnership with multiple stakeholders at the hospital and system. We are agile enough to bring targeted solutions and individualized plans and processes, but also to have the bandwidth to bring subject matter experts into the conversations to drive quality and value. Our focus remains on the client throughout the process, from defining the issue to development of lasting control mechanisms to ensure long-term success. Our commitment to our on-site physician and APP leadership is stellar. We provide the time, tools, and best practice that them to be present in their leadership capacity as well as their clinical capacity.
Often, there may be a perception that you are there to bring corporate medicine to them, and you’re there to commoditize the physician, and they’re just another line on a spreadsheet. But with Core, we are definitely not that. I just spent a full week at a system partner, taking the time to understand and work with everyone there. We are all about driving improvement and flow and partnership with the hospitals, whether that’s through value-based care, or telemedicine, through improving flow for the emergency department we’re about being a true partner to them.
Overall, what makes a good leader of clinical services?
Communication is key, as is a strong clinical background. You must have a strong understanding of the clinical aspects of care as well as process and flow. And then you have to be able to marry both of those together with an understanding of data, statistics, and research.
I think you also have to be available, which means being able to come in on a Saturday morning if that’s what’s needed or spend a night shift working with a provider to understand workflow on a night shift.
You also have to be transparent as a leader. You must be transparent and honest. You have to say, we have an issue in this area, we are not meeting our metric, and we need to fix it. Why? Because it’s better for the patients, for my mom when she comes in, or your brother when he gets into an accident. We want them to have the best care possible.
And finally, you can’t be doctrinaire. So you bring depth of knowledge, experience, and keep that ability to be flexible and agile and targeted. All hospitals are similar and all emergency departments are similar, but at Core, we don’t believe there is a one size fits all solution. Everyone has certain nuances and differences in their department, and there may be individual roadblocks unique to implementing those best practices at that facility. We’re able to bring in those best practices and the long experience of our team, but with the time and the flexibility to really tailor solutions and target them for the client.