The 'small things' will transform healthcare, says Swedish Health Services CEO

Elizabeth Wako, MD, began her career in healthcare as a bedside nurse for behavioral health patients. What she learned during those days has shaped her leadership style as she became a physician, administrator and, in November, president and CEO of Swedish Health Services in Seattle, an affiliate of Providence.

"Healthcare is its own ecosystem. You can enter in any kind of job," said Dr. Wako. "Healthcare is a small city in and of itself. There is no job that exists in the real world that doesn't exist in healthcare. There are so many avenues to enter, and once you enter, anything is achievable. Even being the CEO of a hospital."

Dr. Wako has spent more than 30 years in healthcare and built a career learning many different aspects of healthcare delivery. Then, in 2023, she became interim CEO for seven months before being named the five-hospital health system's permanent leader. Now when she connects with new entrants into the healthcare space, she delivers a simple message: stay open to new opportunities and be creative in how they're thinking about healthcare delivery.

"I always like to connect with new entrants in healthcare because they see things differently and give us a new perspective that we don't see because we are so embedded in it," she said. "Never think that an idea is too small. It's the small things that are going to change how we deliver care."

As a leader, Dr. Wako has been supporting the sort of transformational change in healthcare delivery she wants to see from her team and is focused on building growth. The number one challenge she hears from the community is access to care, and particularly primary care services. Not enough physicians and nurses are entering the field to meet the growing demand for healthcare services. But redefining the way hospitals think about the healthcare front door through virtual care and technology.

"We have to redefine what is the front door in healthcare," she said. "Historically, it has been the doctor's office, but with the healthcare shortages we have right now, that door won't look the same and probably shouldn't look the same in the next few years."

Telemedicine and virtual visits will play a new role in healthcare delivery, connecting with patients more efficiently than in the past. Hospitals are also looking for ways to keep patients with non-urgent issues out of the ER and acute settings and move them into the primary care setting to manage resources and truly deliver value-based care and population health.

Swedish is also transforming its clinician processes for a more team-based model of care instead of one-on-one healthcare delivery.

"When you look at healthcare over time, it does ebb and flow in a sine wave. When the patient population expands and the clinician population contracts, we adapt. Team models for healthcare delivery, whether it's clinicians or APCs, whether it's virtual care or using AI to automate services or triage, we have to change on a regular basis and make it easier for physicians to get to the right decisions quicker."

Technology investment can help solve the access to primary care challenges Swedish and many other hospitals are facing, but another problem remains: how to function with fewer caregivers across the board and ease the way for caregivers so they're able to work to maximum productivity, said Dr. Wako.

"In the end, if we aren't delivering the best clinical and highest quality care, then we aren't living up to our commitment to our patients," said Dr. Wako.

Swedish is also piloting a new virtual nursing model for acute care called Co-caring. The virtual nurses can remotely connect with the patient's room and provide support through bi-directional audio-visual platform.

"Imagine the patient is at the end of their stay and they are ready to discharge, and the nurse goes over things and answers a lot of questions. This person can be the liaison between the clinician and the patient. If the patient or family visits and wants an update, the virtual nurse can come in and summarize care, and let them know what is ahead."

Swedish is building a new medical tower at the First Hill campus to provide high acuity care for patients and it will include a design for more team-based care and innovative leadership.

"The tower will be built with the future in mind," said Dr. Wako. "The virtual nurse program, AI and telemedicine were all considered during the design. The hospital will also decrease our carbon footprint, which is huge."

In the system's legacy hospitals, Swedish leadership are working on ways to bring technology into clinical care, including surgical robots and devices that may not have been available a few years ago. The technology includes wayfinding and virtual care.

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