The pebbles in hospital leaders' shoes

This year brought continued workforce issues and misperceptions about healthcare, but it also inspired health system executives to construct their goalposts for 2024. 

Six leaders answered the question, "In 2023, what was a pebble in your shoe in your work, and how are you trying to shake it out throughout 2024?"

Here's what they told Becker's:

Amy Cain, RN. Chief Quality Officer of West Tennessee Healthcare (Jackson): As I look back on 2023, the persistent pebble in my shoe — for me and my organization — would be the perception that most, if not all, of our current woes are because of COVID-19. While the pandemic was globally destructive with magnitudes of impact on healthcare, it was only part of the reason why our systems of care failed and why it is taking so long to recover. The havoc that COVID-19 wreaked on healthcare across the board was a symptom of other problems we need to solve in our delivery system — both on a micro level (what we can control within our organizations) and a macro level (reliance on supply chain, logistics, funding sources and cooperation versus competition). We also need to resolve the impact of governmental and geopolitical politics on healthcare delivery.

The pandemic shined a light on what we knew how to do well: Come together in a crisis and care for other humans. But it also shined a light on the places our systems of care did not have adequate resilience, where we as leaders in the industry and policy makers had become complacent, or failed to read the tea leaves, so to speak. We allowed competition to become more important than cooperation in one of the most meaningful missions one can engage in — caring for the lives of the vulnerable. The massive impact wasn't solely because of COVID-19; it was because we were not prepared and we didn't have an imagination big enough to be preoccupied with failure on that scale and plan for it. We were not resilient at all levels. 

As I have led through this experience over the past several years, I have come to learn that we need to shed the sense that we are still helpless to the impacts of COVID-19 and take the reins of leadership and remind our teams to focus on what is in our control. We need to guide our teams through the questions and exercises that scrutinize processes and ensure they are resilient. A process for excellent care delivery on Sunday morning at 2 a.m. should be as effective and excellent as that same process Monday morning at 10 a.m. We need to think differently about cooperation versus competition and set about caring for our global community of patients in a more collaborative way.  And as leaders, we also have an imperative to focus on meaningfully caring for our front line, and taking care of all of the people on our team (not only our clinicians — all) who make excellent patient care happen, and by virtue of that, are taking care of the business.

Madeline Camejo, PharmD. Vice President of Pharmacy Services and Chief Pharmacy Officer of Baptist Health South Florida (Coral Gables): Continuing to expand pharmacy clinical roles and opportunities for pharmacists to have a greater impact on patient care. We plan to provide newer innovative services such as clinical wellness, population health and expanding more ambulatory comprehensive clinical services by developing clinical strategies and interventions to improve medication adherence and overall patient treatment outcomes.

Jeremy Cauwels, MD. Chief Physician of Sanford Health (Sioux Falls, S.D.): In 2023, one pebble in our shoe was a challenge that hospitals across the country experienced — difficulty discharging patients to long-term care settings due to workforce shortages. The proposed minimum staffing mandate for nursing homes would be a tipping point for hospitals. There are simply not enough caregivers and nurses available, especially in rural areas, to meet this requirement. As a result, nursing homes will be forced to reduce services or close their doors altogether — only exacerbating bottleneck and throughput challenges for hospitals. 

Another pebble we experienced across the Great Plains was patients traveling further to receive OB and prenatal care as labor and delivery units have closed in small, rural towns due to limited resources. 

As we look to 2024, we are focused on reducing barriers to access care and improving outcomes in rural areas, where two-thirds of our patients live. We are excited about the investments we're making in virtual care and remote patient monitoring technology to bring care closer to home. We are also standing up infrastructure in satellite clinics and piloting a new program in a regional emergency room to monitor patients more closely and intervene sooner to prevent pregnancy-related complications, as well as to guide patient evaluation and stabilization during an obstetric emergency, such as preeclampsia.

The telehealth flexibilities that were put in place during the pandemic have served as a lifeline for our rural providers and the patients we serve, and we need Congress to make those permanent. In addition, states need to allow physicians to treat patients across state lines. In rural America, it's often virtual care or no care. We owe it to our patients to make accessing care the easy thing to do.

Jerry Rebo, PharmD. Director of Pharmacy Value and Outcomes of Novant Health (Winston-Salem, N.C.): Reflecting on 2023, there have been numerous challenges. Workforce shortages, burnout across professions, inflation, cost of goods, engagement and reimbursement challenges just name a few. One pebble in my shoe would be data amalgamation. Currently there are various sources to gathering raw data. Those sources can include finance, sourcing, procurement, utilization and others. Most of the project time is spent rearranging this data into a meaningful format, to allow a comprehensive review to validate questions or identify opportunities. Having a platform to allow these data points to be included into one report would create efficiencies. These efficiencies would translate to spending more time identifying opportunities and making decisions, or allow one to move onto the next question more quickly. As we move into 2024, we are optimistic with the implementation of technology options allowing us to become nimbler and more efficient with our data. Shifting the time spent from arranging data to understanding the opportunities will lead to making more informed decisions. Those actions will have positive impacts for our teams and in the care delivered to our patients.

Edith Okolo, PharmD. Director of Pharmacy of Cedar Crest Hospital & Residential Treatment Center (Belton, Texas): The biggest [pebble] for me as a pharmacist is providing much needed medication or healthcare for every patient despite the cost. We always believe healthcare is available for all, until you come across a patient who cannot continue an antipsychotic, long acting injectable or HIV medications due to cost or lack of coverage by insurance. We are working to find community health centers that provide these medications at subsidized rate. Another issue is shortages and backordered medications. Finding substitutes to these products and also getting the government involved to help with manufacturing process and pharmaceutical outsourcing. Finally, dealing with the rising drug costs and working on keeping budget low by finding generics alternatives and other strategies to keep overhead expenses low.

Peter Pronovost, MD, PhD. Chief Quality and Clinical Transformation Officer of University Hospitals (Cleveland): The "pebble in the shoe" for all of us who work in healthcare, myself included, is the idea that we have to be coldly clinical to be effective. It's a persistent misconception that we can't seem to shake and which impedes our progress. Nothing could be further from the truth. At our institution, we believe the secret of great care is love, defined as the energy that uplifts and connects us all, and we're designing our transformation efforts around it. This may seem like "soft" stuff, but in fact, it's the essential stuff. The results are worth noting. By building our care model around love, for example, we've reduced annual Medicare costs by 33%, saving the Medicare program more than $100 million over four years.

Selling the concept of love to empirically-based clinical folks isn't always easy, but as more results come in, the facts are hard to deny. We'll continue making the case in 2024. We're helped, I believe, by a seemingly unlikely source and the immense cultural moment she's creating for the country — Time Magazine's Person of the Year Person of the Year, Taylor Swift. In everything that's been written about her, one fact is clear: she has a profound belief in people — call it love. Her songs are about hope, suffering and personal triumph, and her concerts are this beautiful way of making people belong. The impact is profound, both in interpersonal connections and economic impact. We in healthcare should sit up and take notice and believe in the power of love with even greater conviction. It's a power for good within and between every one of us that can be harnessed to much greater effect. That's the work for 2024. Perhaps we in healthcare need to be Swifties.

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