A case for acing the basics, per Christus' chief clinical officer

Healthcare is ripe for innovation, but that innovation is less impactful if health systems can't ensure it efficiently reaches patients across the organization. That's where acing the basics comes in, says Sam Bagchi, MD, executive vice president and chief clinical officer at Christus Health. 

"If you do the basic things really, really well, I think you can have incredible results," he told Becker's

One of Dr. Bagchi's top priorities for this year — and the next — directly aligns with this mindset. The Irving, Texas-based system is on a journey to improve length-of-stay management and achieve more efficient care across its 60-hospital footprint.

"There's a lot of really interesting and innovative things we can do," he said. "But if we can't do it across an efficient platform of care where patients are getting the right care, at the right place, at the right time, then it's less meaningful of an innovation because less people are able to receive it."

Dr. Bagchi recently spoke with Becker's about the health system's progress on length of stay, his other top priorities over the next 12 months and more. 

Editor's note: Responses have been lightly edited for length and clarity.

Question: In a 2021 Becker's podcast, you described the importance of getting "back to the basics" with regard to care and operating principles before any type of major reinvention can occur. Where is Christus on this journey? 

Dr. Sam Bagchi: I'll fill you in on a little secret. I'm a pretty simple leader when it comes to these types of prioritization exercises. Getting back to the basics paid off for us in 2021 because we were so thrown off on our normal cadence and our focus on COVID-19. Thinking about how to maintain our capacity with better length of stay and more efficient processes was really important because our cost pressures, demand for services and acuity in our populations is so high. We just have to do more with the same amount of resources or maybe even less resources if we can. 

I'm happy to say we've made a fair amount of headway in terms of our length-of-stay management. We were able to shave half a day off length of stay networkwide last year in our U.S. operations. That's thousands of more episodes of care we were able to provide with the same nurse staffing, the same physician staffing and the same physical facilities. I know that's kind of basic, but it really drives outcomes that are important to our communities because our patients and our families want to have access to us when they need us.

Q: What strategies have proven most effective at reducing length of stay?

SB: A lot of organizations — and we're guilty of this too — look to care management leaders to understand where we have opportunities for improvement in length of stay. But we can't just hold those stakeholders accountable for such a complex outcome. When you think about barriers to improving length of stay, it's not one or two things. It's solving a hundred problems a day for clinicians, patients and families to really connect the dots for the most efficient hospital care.

Each of our sites have an interdisciplinary team working together every day to solve problems. It's not just the care management team — our chief medical officers, chief financial officers and CEOs at the facility level are aware of the obstacles and issues, and are helping the team solve them. We focus on making sure there are several opportunities per day at every one of our facilities for teamwork to happen, where we're identifying and solving those obstacles. 

So often, physicians are blamed for keeping patients in the hospital too long or doing outpatient workups in the hospital when they can do it at home instead. We also have to listen to our physicians as to where they see the barriers or what they're struggling with. For example, it's hard for them to put patients through their care journey efficiently if a CT scanner or physical therapy isn't available on the weekend, so we have a task force at each site that ensures weekend services are available as needed. We're going to keep focusing on length of stay over the next year because it's so meaningful. 

Q: What are your other top priorities over the next 12 months?

SB: Sepsis is something that we're going to continue to work on and try to better integrate our sepsis care from the moment patients present to us, even if that's in our ambulatory settings and all the way through emergency care, hospital care, critical care and then discharge and post-discharge. So we're really thinking about sepsis on that full continuum, because it is such an important condition for the communities that we serve. 

We're also retooling our EMR strategy to bring a single platform to every access point across Christus Health. We, like other health systems, have grown through organic growth, but also through acquisition and different partnerships we have, so different EMRs came into our organization at different times. We're really excited that we're going to be able to offer the highest and best use of the Epic platform at every access point where our patients experience their care. That was my top priority last year and will be something that continues to be a top priority this year. And not just for me as the chief clinical officer, but for all of our clinical leaders because if you just do an EMR project to get the technology in and you don't do it to drive the outcomes you're trying to achieve, then you don't end up getting the return on investment for these large projects that you really want. 

Another priority is health equity. How do we get the best care we can offer to all of our communities and to everyone who seeks our care? We've realized health equity and social determinants of health efforts can be kind of overwhelming for our front-line staff who feel like sometimes it's challenging just to get the basic things done that we asked them to do every day — or even the advanced things done every day. Asking patients about things like access to food or transportation can be overwhelming if you don't have a good answer or solutions for patients. 

We're trying to focus our efforts on a more narrow scope that aligns with our quality and health outcomes priorities. For example, we've decided to align our hemoglobin A1C control quality measure with a couple social determinants of health that relate to diabetes patients' challenges with their condition. These include access to healthy food and access to medications. So when we talk to our clinicians about asking patients about these social determinants of health, we can say it aligns with things that they're already accountable for and working on. We're going to work with our mission team, social work team, value-based care team and community health workers to identify how we can connect patients who have access to food issues to food banks or other resources. We also have a big focus on retail pharmacy and how we can make it easier for patients to get the medications they need, whether it's sending the medications directly to their home or helping them get involved in manufacturer rebate programs.

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