Rural practices should be physician-led in collaboration with a care team that includes advanced practice providers and nurses, this CMO says.
In rural medicine, the patient should be at the center of a care team and care teams should be physician-led, the CMO of Avera Health says.
Kevin Post, DO, has served as CMO of Avera since 2023. Prior to taking his current position at the Sioux Falls, South Dakota-based health system, he had been CMO of Avera Medical Group since 2020. His clinical background includes serving for 12 years as a rural family medicine physician.
As is the case in all medical fields, rural family medicine caregivers must put the patient at the center of the care team, according to Post.
"Physicians, advanced practice providers, and nurses are all key, but the patient is the most essential component of the care team," Post says. "They need to be engaged in their care and involved in decision-making with their caregivers."
In terms of staff, there should be a physician leader who has a team-based mindset at rural medical practices, Post explains.
"Then you must leverage the team around the physician, which includes APPs, nurses, care coordinators, and patient service representatives," Post says. "All of these other professionals are key to having a team that has a mindset of how you can take care of the patient and the patient's family."
Rural family medicine caregivers must engage with the community, according to Post, because that engagement is essential to success in rural medicine.
"There should be community engagement such as participating in leadership boards in the community and volunteering at organizations," Post says. "In rural communities, people want to see their care team embedded in their lives."
Technology is also important in rural medicine. Post says that Avera is leveraging telehealth, AI-supported care delivery, and portal messaging to provide the most access to the most patients.
"At Avera, we have a rural footprint spread over 72,000 square miles," Post says. "It can be a challenge to provide access to specialty care in rural communities."
To address workforce shortages at its rural hospitals, Avera has been focusing on nurse staffing.
"We have started a collaboration with our local nursing schools to double and sometime triple the size of the nursing schools," Post says. "We have started nursing residencies, so as we hire nurses, we can train them on a wide array of skills, which increases their longevity because they feel comfortable in their role."
Retention has been a primary strategy to address the nursing shortage at Avera's rural hospitals, Post explains.
"When it comes to nurse staffing, you need to take care of the nurses that you have," Post says. "We make sure they are recognized. They feel relevant. They see that what they are doing matters. They feel appreciated and engaged, so they want to stay with us."
Kevin Post, DO, is CMO of Avera Health. Photo courtesy of Avera Health.
Success in physician engagement
Post embraces the mantra: "As goes the clinicians, so goes the organization."
"You must have the right lens as you look at your physicians and APPs," Post says. "We see our caregivers as partners and leaders within the health system. At Avera, we say we are clinically led and professionally managed. It is important that our physicians feel they have a voice and a seat at the table."
From a physician standpoint, engagement centers on the patient and the organization, according to Post, and the reward is care quality and patient experience.
"They also need to believe in the cause of the organization, the mission of the organization, and the values of the organization," Post says. "They must have a voice at the table in organizational decision-making."
Avera has several ways to give physicians a voice, Post explains.
"It starts with personal and professional development because we want to give physicians the education they need and the information they need to have a voice in the organization," Post says. "We inform physicians, so they can contribute to decision-making with their expertise and organizational understanding."
Physicians also play leadership roles at Avera. According to Post, there are three physicians on the board of directors, two physicians in senior leadership, and physicians leading the 13 service lines.
"There was a physician group that helped us develop our strategic plan," Post says. "We also have physicians at the table when it comes to growth projects."
Promoting care quality
To boost care quality, Post recommends that CMOs and other leaders create an environment where every staff member values why they come to work every day, by remaining patient-centered and fostering a mindset of continuous learning.
"We want to disseminate the learning that we have, so we have a collective memory and a progressive approach to applying new ways of delivering care," Post says. "We have established a culture that makes it easy to do the right thing."
Patient safety is linked to quality, and Avera has a patient safety improvement collaborative to identify good catches of safety issues.
"Our employees feel comfortable speaking up," Post says. "We have a culture of safety that encourages staff to speak up when there might be a risk to patients. We reward people for raising their hand if a mistake is made."
Rewards for speaking up include a Good Catch Award, which is recognized at senior leadership meetings and presented to employees at the local level.
To promote care quality, CMOs need to lead by example and remove barriers for people, Post explains.
"I need to make sure that the right systems and processes are in place, so our leaders can be successful in pushing that to the frontline of care," Post says. "As a leader, you can never forget that you are not the person who can achieve the quality of care at the bedside — it is the frontline staff. I need to help give resources, education, and efficient workflows to our staff."
As a leader, Post says he needs to have "sensitivity to operations" to support quality care.
"I need to be aware of how the decisions I make will play out at the frontline," Post says. "A decision can feel much different in the boardroom than it does in the exam room."
In the pursuit of quality care, a CMO must defer to expertise, according to Post.
"I need to get the people closest to the work to help make the decisions because they are the ones that understand the work best," Post says. "You need to have organizational humility to bring in those who are closest to the work, so correct decisions are made."
Christopher Cheney is the CMO editor at HealthLeaders.
KEY TAKEAWAYS
Rural family medicine care team members should be engaged in their community.
Technology such as telemedicine is an important component of a successful rural medicine strategy.
At Avera Health, efforts to address workforce shortages at rural hospitals have focused on nurse staffing.