At Ochsner Health, about 70% of the patients who have engaged with the health system's virtual emergency department have avoided emergency room visits.
Emergency room crowding is a challenge for health systems and hospitals across the country. Creating a virtual emergency department is a relatively new concept to address the problem, and it's a concept that Ochsner Health is turning into strategy.
Ochsner started its virtual emergency department in October 2024. The virtual emergency department is staffed by a board-certified emergency medicine physician and nurse navigator from 8 a.m. to 8 p.m. seven days a week.
So far, the virtual emergency department has worked with 13,000 patients. In 70% of these cases, patients have been able to receive care without visiting a brick-and-mortar emergency room.
"Originally, the concept came out of our overall journey to try to get patients to the right care in the right place," says Lisa Birdsall Fort, MD, system medical director of quality for emergency services at Ochsner. "We found that we had disproportionate ED utilization, so we needed a solution to help to make sure that we were able to connect patients to the right care."
From a CMO's perspective, the virtual emergency department program generates strategic, clinical, and financial value, according to Sidney "Beau" Raymond, MD, CMO of Ochsner Health Network. It improves access and convenience by allowing patients, particularly those with low-acuity conditions or living in rural areas, to receive timely care from emergency physicians without needing to physically visit the emergency department.
"This model enhances cost efficiency by reducing unnecessary ED visits and redirecting patients to more appropriate ambulatory or virtual care settings, which ultimately lowers overall healthcare spending," Raymond says. "Additionally, the program helps optimize resources by preserving high-acuity ED capacity for true emergencies, thereby improving throughput and reducing burnout among emergency staff."
The virtual emergency department addresses several pain points for CMOs, including alleviating ED crowding by offering patients more appropriate access points for care, Raymond explains.
"Many patients choose the ED for convenience or payment flexibility, but the virtual emergency department provides a viable alternative that maintains accessibility while improving care flow," Raymond says. "The program functions as a centralized hub, guiding patients to the right care setting, whether that be virtual, urgent care, primary care, or even specialty follow-up."
For patients, the virtual emergency department elevates patient satisfaction and outcomes by reducing wait times, improving care navigation, and offering personalized treatment plans, Raymond says.
Sidney "Beau" Raymond, MD, is CMO of Ochsner Health Network. Photo courtesy of Ochsner Health.
How Ochsner's virtual emergency department works
Patients are referred to Ochsner's virtual emergency department from primary care offices, specialist offices, urgent care centers, or the health system's nurse-on-call line, according to Noah Pores, MD, medical director of the virtual emergency department.
"If patients are triaged in such a manner that emergency care is felt to be needed, the virtual emergency department will be consulted through the Epic secure chat platform," Pores says. "From there, we engage with providers in a brief conversation about the case and review medical records such as images and laboratory results."
The virtual emergency department makes a care recommendation for patients based on the conversation with their providers, Pores explains.
"We ask questions of physicians or nurses, depending on which staff member is consulting with us," Pores says. "Then we make care recommendations about whether emergency care is appropriate."
If it is determined that emergency care is not appropriate, the virtual emergency department has several options to provide care. The patient can be offered a virtual visit such the video teleconferencing platform via Epic. The patient can be offered an e-visit, which is an asynchronous type of virtual visit that involves a survey submission by the patient. In an e-visit, the virtual emergency department physician can review the survey responses and provide services such as prescriptions, ancillary tests, or referrals.
The virtual emergency department also redirects patients to care settings that avoid an emergency room visit.
"We answer questions for patients, and many times the needs that they have can be resolved in the outpatient setting, which they can find difficult to navigate," Pores says. "The nurse navigator is the unsung hero in our virtual emergency department model. Their ability to schedule patients quickly for primary care and specialty clinics has been a game changer for us as a health system."
Noah Pores, MD, is medical director of the virtual emergency department at Ochsner Health. Photo courtesy of Ochsner Health.
The future of virtual emergency departments
Virtual emergency department programs are poised to become a national trend, according to Raymond, who adds that Ochsner's virtual emergency department program uses existing technology to address EDs that are filled with non-emergent patients
"It enables patients to be seen at the most appropriate site of care," Raymond says. "Traditional nurse triage lines, which most health systems use, are limited by protocol. By incorporating experienced ED physicians into the triage process, our virtual emergency department ensures that patients who would otherwise be sent to the ED due to protocol limitations can instead receive the necessary evaluation and management in a more suitable setting."
Health systems and hospitals that are interested in starting a virtual emergency department program should be prepared to apply a significant level of effort, according to Birdsall Fort.
"A virtual emergency department is not something that comes out of a box from an electronic health record vendor—it is a relatively new concept," Birdsall Fort says. "You need to be creative. You need to start the program, then refine what you offer."
It is important for a healthcare organization to establish buy-in for a virtual emergency department program, Pores explains.
"A virtual emergency department requires a lot of coordination across multiple stakeholders, including primary care, executive teams, quality departments, and population health programs," Pores says. "You also need a strong group of physicians who are willing to be engaged in the process."
Lisa Birdsall Fort, MD, is system medical director of quality for emergency services at Ochsner Health. Photo courtesy of Ochsner Health.
A recent study found 7.4% of emergency departments lack 24/7 coverage by attending physicians.
Hundreds of emergency departments do not provide 24/7 coverage by attending physicians, particularly at rural hospitals, according to a recent study.
The study, which was published by the Journal of the American College of Emergency Physicians Open, examined 2022 data from 4,621 emergency departments. The researchers found that 344 (7.4%) of the EDs did not have 24/7 attending physician coverage. The states with the highest percentages of hospitals where there was not 24/7 attending physician coverage of emergency departments were North Dakota, South Dakota, and Montana.
Sioux Falls, South Dakota-based Sanford Health struggles to have 24/7 attending physician coverage at its emergency departments in rural communities.
"We cover about 55 medical centers throughout the Upper Midwest. Some of those facilities are Level 1 trauma centers and are well-equipped to handle most emergencies," says Jeremy Cauwels, MD, CMO of Sanford Health. "Some of those facilities are in towns of about 800 people, and they have either a low volume of patients or low condition acuity to support a physician in their emergency departments on a regular basis."
The CMO of Sioux Falls, South Dakota-based Avera Health says it is difficult to find emergency medicine physicians to work at rural hospitals.
"It is challenging for us to have full-time physician coverage at our emergency departments, especially at our rural communities and settings, where recruitment for physicians is difficult," says Kevin Post, DO, CMO of Avera Health. "When you think about recruiting physicians for a small, rural community, when the physicians are not from that area it can be difficult."
Recruitment of emergency medicine physicians to work at rural hospitals is also a predicament for Sanford Health.
"The biggest challenge is finding a physician who wants to live in a town of 800 people," Cauwels says.
The absence of attending physician coverage at many emergency departments is a trend that will continue in the future, according to Post.
"We are facing an increasing physician shortage that will not lift for at least the next five to 10 years," Post says. "We need to acknowledge the physician shortage is the reality, then be proactive about what we can do about the shortage."
Jeremy Cauwels, MD, is CMO of Sanford Health. Photo courtesy of Sanford Health.
Rising to the staffing challenge
To provide adequate full-time clinician coverage of emergency rooms in the absence of an attending physician, Sanford Health and Avera Health rely on advanced practice providers (APPs).
"If we have a scenario where a physician is unable to cover an emergency department, we will have the staff at a rural hospital covered by an advanced practice provider such as a certified nurse practitioner or physician assistant," Post says. "It is important for these APPs to have the adequate training to serve in this role and adequate staff to support them."
With the right experience and training, an APP is equipped to provide care for 90% of the patients who seek care at an emergency room, according to Cauwels.
"Many of the patients who come into emergency departments are already managed in small towns and big cities by APPs," Cauwels says. "If you walk into a large hospital emergency department in Minneapolis, you will be seen by an APP in many situations, particularly for triage."
Avera Health and Sanford Health provide training for APPs who are overseeing emergency rooms.
"At Avera, we are exploring additional emergency medicine certification for our rural nurse practitioners and physician assistants, so they can have additional training specifically for rural emergency medicine," Post says. "This will help address the challenges of having limited resources at a rural facility."
Sanford Health provides simulation training for APPs who are leading emergency rooms.
"We have a motor home full of manikins that goes to hospitals throughout our footprint to train APPs on care such as how to deliver a baby precipitously, how to insert a chest tube, and how to manage an emergent airway," Cauwels says. "We actively engage with our teams to make sure they have those skills."
Kevin Post, DO, is CMO of Avera Health. Photo courtesy of Avera Health.
Leveraging telehealth
Avera Health and Sanford Health provide APPs who are overseeing EDs with access to emergency medicine physicians and specialists through telehealth. At Avera Health, Post explains that the health system has embedded telehealth technology into its rural emergency departments.
"With the push of a button, an emergency medicine physician and nurse can be available in an exam room," Post says. "These professionals can interact with the APP and the entire care team. It can be as simple as assisting with documentation or as complicated as helping with care guidelines."
Sanford Health supports APPs with telehealth at 31 of the health system's rural hospitals.
"APPs can get a virtual consult in real-time while they are treating a patient," Cauwels says. "These virtual consults include neurology, psychiatry, and board-certified emergency medicine physicians."
Using telehealth to support an APP at an emergency department ensures that patients receive quality care despite the absence of an attending physician on-site, Cauwels says.
"A physician does not have to live in a rural town to digitally appear in an exam room at a hospital and do the right thing for the patient," Cauwels says. "With digital technology, we can have physicians work with patients in real-time in small town emergency rooms."
Since 2023, physician productivity as measured by work relative value units has increased 12%, and APP productivity has increased 11%, according to Kaufman, Hall & Associates.
With a nationwide shortage of physicians in many specialties, it is important for health systems, hospitals, and medical groups to achieve high productivity from the clinicians they have on staff. Lower levels of productivity can be a major barrier to growth.
The Physician Flash Report has three key takeaways.
Since 2023, physician productivity as measured by work relative value units (wRVUs) has increased 12%. APP productivity has increased 11%.
Net patient revenue per provider overall has also increased, although there was a slight decrease in surgical and hospital-based revenue that is likely related to an increase in outpatient care.
Medical support staff levels have decreased, which likely stems from difficulties with hiring and retention of medical support staff such as medical assistants.
Daniel McGovern, MBA, is vice president of finance for Virtua Medical Group. Photo courtesy of Virtua Health.
How the trends have played out at a large medical group
Over the past two years, physician and APP productivity have increased at Virtua Medical Group. Since 2023, the medical group has posted a 16% increase in physician productivity and a 17% increase in APP productivity, according to Daniel McGovern, MBA, the medical group's vice president of finance.
Clinician retention has been a primary driver of productivity gains at the medical group. If there is a lot of turnover and onboarding of new physicians and APPs, McGovern explains, the productivity on average will be lower for a medical group.
"With turnover, there is a ramp-up period, where physicians and APPs are learning about the health system, the electronic medical record, and building up patient panels," McGovern says. "Overall, we have been very fortunate with retention, with a 96% retention rate for our provider workforce."
Several initiatives at the medical group have contributed to the increase in physician and APP productivity, according to Samuel Weiner, MD, vice president and CMO of Virtua Medical Group.
"We have done things that are not necessarily directed at increasing productivity but have had a side effect of increasing productivity," Weiner says. "This includes making our electronic medical record easier to use. We have made the interface easier to use, so our clinicians can get through clinic visits quicker and with more direct contact with the patients."
Efforts to make the medical group's electronic medical record easier to use have included integrating artificial intelligence into the EMR. For example, AI is helping to answer questions that are sent to clinicians through the medical group's patient portal.
"The AI can generate a response back to the patient to get the conversation started," Weiner says. "The clinician still needs to send the answer back, but the AI goes a long way to answering clinical questions, with the clinician tailoring the response."
The medical group also is using an ambient listening tool to record the interactions between clinicians and patients, then generate a clinical note of the encounter to ease the documentation burden for clinicians.
"The ambient listening tool not only makes clinicians more efficient but also gives them the opportunity to squeeze a patient in for an appointment at the end of the day if a patient needs an appointment at the last minute," Weiner says.
Since 2023, Virtua Medical Group has experienced about a 1% decrease in net revenue per wRVU for its surgical specialty and musculoskeletal specialty.
"Our inpatient surgical volume has not decreased. It has actually increased, especially in terms of our transplant physicians and cardiovascular physicians," McGovern says. "However, with our growth, we have had a lot more outpatient volume in general at Virtua Medical Group, which has shifted the percentage of net revenue to the outpatient side."
In 2023, Virtua Medical Group had about 38% of service volume coming from inpatient services. This year, about 34% of service volume is coming from inpatient services.
"We have been performing more office procedures, particularly with the acquisition two years ago of a large musculoskeletal group," McGovern says. "They do more than 5,000 office procedures per year, which has shifted some of our portfolio to the outpatient side."
The medical group has also experienced a rise in procedures conducted in ambulatory surgical centers, according to McGovern.
Virtua Medical Group has bucked the trend of lower medical support staff levels.
"We have been able to increase our medical support staff levels in recent years," McGovern says. "We have found that productivity will drop in clinician offices if they do not have enough support staff. We have increased the number of support staff by 11% over the past two years at the request of the practices."
Maintaining competitive medical support staff compensation has been crucial, McGovern explains.
"We are fortunate to have support from our corporate compensation department, which has been doing regular market reviews of support staff salaries," McGovern says. "We make adjustments if salaries fall below the market rates. That has helped to ensure that we are paying market value for our medical support staff positions."
Samuel Weiner, MD, is vice president and CMO of Virtua Medical Group. Photo courtesy of Virtua Health.
In the hospital setting, care coordination often starts in the emergency department, this CMO says.
Care coordination is an important consideration for CMOs because patients often interact with multiple care providers when they receive services for a health condition, the new president and CMO of Newport Hospital says.
In the hospital setting, care coordination often starts in the emergency department, where physicians and nurses provide care to patients that can involve interactions with providers in several specialties, according to Thomas.
"You need care coordination involving staff members such as case management, social work, and pharmacy," Thomas says. "The staff members who are impacting the patient need to coordinate their care, so that the patient has a safe discharge, can get back to their primary care doctor, and not have to come back to the hospital."
In general, Thomas says the primary element of success in care coordination is ensuring there is alignment between key stakeholders who are providing care to a patient.
For example, Thomas helped achieve this kind of alignment in a care coordination initiative designed to reduce hospital readmissions.
The initiative featured a multidisciplinary group that included inpatient and outpatient providers, pharmacists, care transition staff such as social workers, and case managers. Members of the group worked together to make sure that patient information was available to every provider working with a patient and to come up with strategies to make sure patients had access to specialty care as needed. Another goal of the group was to make sure that patients got the services they needed despite their social determinants of health.
Generating positive outcomes through care coordination helps to drive alignment between care providers.
"Success begets success in care coordination," Thomas says. "As you start seeing better quality scores and better patient satisfaction, that creates an incentive for different providers to participate in care coordination efforts."
Tenny Thomas, MD, is president and CMO of Newport Hospital, which is part of Brown University Health. Photo courtesy of Brown University Health.
Culture critical in quality improvement and patient safety
Health systems and hospitals must have a culture that supports quality and patient safety, according to Thomas.
"Quality and patient safety are the main components of the engine that make a healthcare organization run effectively," Thomas says. "It is important to build that culture in the frontline staff as well as among the leadership of the organization."
There are several elements in building a culture that supports quality and patient safety, including safety mechanisms like checklists, Thomas explains.
"You need to have a strong reporting culture about things that are happening in your health system or hospital," Thomas says. "You need to have daily or weekly reviews of incident reports to determine whether there are serious quality or safety concerns that need to be addressed."
Promoting a just culture is crucial, according to Thomas. This means not focusing on individual faults when something goes wrong.
"You need to understand the reasons behind when something goes wrong, which is often a process issue," Thomas says. "You need to conduct root-cause analyses to understand what went wrong, then modify processes as needed."
One area where a CMO can have a positive impact on quality and patient safety is hospital-acquired infections, Thomas explains.
"I have made sure that a hospital adopts best practices, which have been validated in the literature and across different organizations," Thomas says. "These evidence-based practices can decrease hospital-acquired infections such as catheter-associated infections, central-line infections, and bed sores."
Improving patient flow in the hospital setting
To improve patient flow in a hospital, prioritization of services and making sure there is alignment between different departments is essential, according to Thomas.
"The key to success is clear and transparent information flow between all of your departments, including radiology, ancillary services, and laboratory services," Thomas says. "A CMO needs to help hospital departments align their prioritization. For example, departments should be aligned on the different elements of care that patients need, which helps improve patient flow."
Thomas says one way to align priorities between departments and promote transparency is to create a multidisciplinary group to standardize operations within a hospital on a daily basis, so that care is prioritized for patients who are going to be discharged to provide timely care.
Harnessing data is a primary factor in improving patient flow, Thomas explains.
"If there is a particular group of patients who are being delayed from being discharged because of the lack of a resource, if you can recognize this situation through data, then you can invest in that resource to make sure it is expeditiously available to boost patient flow," Thomas says.
For example, a hospital may have a CT scanner and an MRI machine, but data shows that there is a lack of technicians to provide imaging on a timely basis.
"In that case, you can bring in more technicians because the demand for the service is so high," Thomas says.
Sentara Health has set a goal of doubling the health system's resident positions.
Michael Hooper, MD, MSc, senior vice president as well as chief medical and academic officer of Sentara Health, says the drive for a dramatic increase in the number of residents at the health system is designed to bolster the organization's physician workforce.
"We are trying to work with our academic partners to increase the number of resident slots, so we can help address the physician shortage that everyone is experiencing across the country," Hooper says.
View the video below to find out how Sentara Health is working to increase its resident positions. Click here to read the accompanying HealthLeaders story.
CMOs should assemble multidisciplinary care teams for high-risk pregnancies, an expert at Yale New Haven Children's Hospital says.
High-risk pregnancies are increasing, and CMOs need to put resources in place to address them.
Hospitals in Florida are forecasting a 14.5% increase in high-risk pregnancies over the next decade, and the trend is expected to be nationwide. According to Cleveland Clinic, the causes of high-risk pregnancies include pre-existing conditions in women such as diabetes, high blood pressure, and obesity, as well as pregnancy-related health conditions such as gestational diabetes, low birth weight, and preeclampsia.
There is no doubt that high-risk pregnancies are increasing, according to Mert Bahtiyar, MD, director of the Fetal Care Center at Yale New Haven Children's Hospital. On the maternal side, there are patients with increased high-risk factors such as high body mass index, chronic hypertension, previous surgeries, and malignancies. From the babies' perspective, there are more high-risk factors, including genetic and structural abnormalities.
"We look after two patients, the mother and the baby," Bahtiyar says. "We are seeing increases in high-risk medical conditions in both populations."
A CMO should be aware of the trend and the capabilities of their organization to provide care for high-risk pregnancies, Bahtiyar explains.
"If they put resources in place and utilize those resources wisely, then care for high-risk pregnancies is less of a challenge and more of a service that needs to be provided," Bahtiyar says. "Being proactive is better than being reactive."
First and foremost, CMOs need to assemble multidisciplinary care teams to address high-risk pregnancies, according to Bahtiyar.
"There is no single provider who can handle high-risk pregnancies," Bahtiyar says. "A CMO needs to be aware of the trends in high-risk pregnancies and hire staff accordingly. A CMO needs to support the members of maternal health teams."
For example, if a congenital heart defect is diagnosed, the care team should include a pediatric cardiologist, a pediatric cardiology surgeon, the staff of a newborn intensive care unit, and care coordinators and patient navigators, Bahtiyar says.
With multiple providers and patient visits involved in high-risk pregnancies, care coordinators and patient navigators are essential members of the care team, according to Bahtiyar.
"With care coordinators and patient navigators, instead of the mother going around to receive care from multiple providers, the care is tailored and organized by the care coordinators or the patient navigators," Bahtiyar says. "Care coordinators and patient navigators are advocates for the patient."
High-risk pregnancies and the care for them are evolving, so a CMO must be nimble, Bahtiyar explains.
"Instead of having just a fixed team, a CMO should be willing to adjust the members of the care team and provide in-service training for the team," Bahtiyar says. "A CMO needs to be adaptive and open-minded."
Mert Bahtiyar, MD, director of the Fetal Care Center at Yale New Haven Children's Hospital. Photo courtesy of Yale New Haven Health.
High-risk pregnancy services at Yale New Haven Children's Hospital
Yale New Haven Children's Hospital provides a range of services when there is a high-risk pregnancy. Bahtiyar cited examples of care that is provided to mothers and their babies.
From the mother's perspective, if a patient has diabetes, the hospital has a diabetes program from diagnosis to management and handing the patient over to their primary care physician after childbirth. The hospital has a maternal cardiac program that addresses chronic hypertension and other cardiac abnormalities during pregnancy such as congenital heart defects. The cardiac program is a combined program between adult cardiology and maternal obstetrics. The hospital also has a prenatal genetics program.
From the baby's perspective, the hospital has fetal cardiology services such as fetal echocardiograms. The hospital also has the capacity to perform in utero procedures such as blood transfusions for anemic babies, placing shunts in the abdomen or chest of a baby, and operating on the placenta.
Having services in place for mothers and their babies in high-risk pregnancies is generating positive clinical outcomes, according to Bahtiyar.
"What we know is that controlling diabetes in mothers decreases congenital heart defects in newborns and avoids unnecessary cesarean sections," Bahtiyar says. "Controlling blood pressure prevents the mother from having cardiovascular incidents during pregnancy."
"The ability to be able to diagnose and intervene for medical conditions of the fetus in utero improves the outcomes for newborns," Bahtiyar says. "Recognizing these conditions before childbirth is important, so that we have resources in place at the time of delivery for newborns and their mothers."
With the brisk pace of artificial intelligence tool expansion, CMOs and other healthcare leaders should have policies in place for AI tool adoption and governance.
The American Medical Association (AMA) has released guidance for health systems and hospitals on artificial intelligence governance and adoption.
With the expansion of AI tools in healthcare, having AI governance and adoption policies in place is important for CMOs and other healthcare leaders. The rapid pace of change in AI tool adoption in healthcare makes these policies essential, according to the AMA.
"Technology is moving very, very quickly. It's moving much faster than we're able to actually implement these tools, so setting up an appropriate governance structure now is more important than it's ever been because we've never seen such quick rates of adoption," Margaret Lozovatsky, MD, chief medical information officer and vice president of digital health innovations at the AMA, said in the organization's guidance document.
The AMA says there are eight foundational elements for responsible AI adoption:
Establishing accountability and structure for executives
Forming a working group to detail priorities, processes and policies
Assessing current policies for AI adoption
Developing new policies for AI adoption
Defining project intake, vendor evaluation and assessment processes
Updating standard planning and implementation processes
Establishing an oversight and monitoring process
Supporting AI organizational readiness
How health systems are managing AI governance
AI governance has been a hot topic in the HealthLeaders AI in Clinical Care Mastermind program.
Providence is taking a comprehensive approach to AI governance, the health system's former chief clinical officer told HealthLeaders.
"Our approach to the use of AI tools is methodical and anchored in our mission, values, and organizational vision and priorities," said Hoda Asmar, MD, MBA, former executive vice president and system chief clinical officer for Providence. "While we believe AI advancements have the potential to elevate quality of care and allow our caregivers to perform at the top of their license, the safety and security of our patients and their data will always be our top priority."
Providence has assembled an AI governance structure to ensure alignment around priorities and strategy, patient safety, privacy, security, equity, and the ethical use of AI, Asmar said.
Several panels are involved in AI governance at Providence, including an AI guardrails workgroup led by the health system's chief data officer, an information protection committee led by the health system's chief information security officer, and a data ethics council led by the health system's chief ethicist.
Health systems should put a governance structure in place early in their AI adoption efforts, according to Patrick McGill, MD, MBA, executive vice president and chief transformation officer at Community Health Network.
"You need to have the governance in place to make sure that you understand all of the tools that are being used, how the tools are being used, the intended outcome of usage, and how you mitigate bias," McGill told HealthLeaders.
Community Health Network has an executive steering committee to help the health system identify and prioritize AI tools and use cases. The committee is led by the health system's director of AI and data governance, and members of the panel include McGill as well as the health system's CMO, CFO, chief physician executive, chief information officer, and technical staff from the IT and analytics departments.
Prior to establishing the executive steering committee, Community Health Network began the process of creating AI governance capabilities. "We have put in policies, procedures, and guardrails for the appropriate use of AI," McGill said.
UMass Memorial Health has also established an AI governance committee specifically designed to help conduct the adoption and implementation of AI tools in clinical care.
"We are establishing a policy and a process for working through the different kinds of AI tools that are being requested at the organization," Eric Alper, MD, chief quality officer and chief clinical informatics officer at UMass Memorial, told HealthLeaders. "The AI governance committee will help us implement AI tools in the safest way."
The health system's AI governance committee includes clinicians, IT staff, legal team members, risk management staff, ethicists, and staff who are focused on health equity.
Healthcare organizations can teach clinicians and nurses compassionate communication skills, including deep listening, clarity, and understanding patients' perspectives.
Compassionate communication is essential to establish trust between clinicians and their patients. Trust is foundational in creating meaningful connections and working relationships with patients.
"What we teach is all about the communication and connection between clinicians and patients," says Evonne Kaplan-Liss, MD, MPH, director of the Center for Compassionate Communication at the UC San Diego Sanford Institute for Empathy and Compassion. "An emotional connection between a clinician and a patient is established in the first two minutes of a clinical encounter."
View the video below to get Kaplan-Liss' insights on the fellowship program. Click here to read the accompanying HealthLeaders story.
Artificial intelligence tools, telehealth, and redesigning care models are among the effective approaches to boosting access, this CMO says.
The new CMO of Sentara Health has been involved in efforts such as redesigning care models to improve access to care.
Michael Hooper, MD, MSc, became senior vice president and CMO of Sentara Health in March. He retained his prior role as chief academic officer. His previous experience includes serving as CMO of Sentara Norfolk General Hospital.
Hooper is helping Sentara to redesign care models and use artificial intelligence tools, telehealth, advanced practice providers, nurses, social workers, and care managers to increase access to care.
"We have a process in place for care model redesign to look at our workflows and the way we interact with patients," Hooper says. "We want to match the needs of our patients with the most appropriate communication methodology and personnel to give them advice, make diagnoses, and come up with treatment plans."
Regarding advanced practice providers, nurses, social workers, and care managers, Sentara is actively looking at how the health system can maximize the use of those staff members in the ambulatory setting and hospital setting in more robust healthcare professional teams.
"This will allow us to take care of more patients and improve access to care while still maintaining or improving the quality of care that we provide," Hooper says.
Like many other healthcare organizations, Sentara has seen an explosion of telehealth capabilities since the coronavirus pandemic.
"We continue to use telehealth in hospital-based care, emergency medicine, and ambulatory care to increase access to care and make interactions with patients more convenient and efficient," Hooper says.
Embedding artificial intelligence tools in clinical workflows is helping Sentara to see more patients without straining the health system's workforce.
"Notable examples of AI tools we are using include a telenursing capability that we have inserted into many of our hospitals," Hooper says. "This use of AI is a way for us to take some of the routine nursing care that does not require hands-on effort and use a virtual nurse to do tasks such as medication reconciliation and patient education at discharge."
Stroke services, where timely care is essential for positive clinical outcomes, is another example of where AI is improving access to care at Sentara.
"When potential stroke patients come into our emergency rooms, they get rapid access to CT scans and stroke neurologists combined with an AI tool that reads their scan faster than a radiologist could," Hooper says.
Michael Hooper, MD, MSc, is senior vice president as well as chief medical and academic officer at Sentara Health. Photo courtesy of Sentara Health.
Effort to double number of residents
Hooper is involved in an initiative to double the number of residents at the health system.
"We are trying to work with our academic partners to increase the number of resident slots, so we can help address the physician shortage that everyone is experiencing across the country," Hooper says.
Sentara operates 12 hospitals, with 11 hospitals located in Virginia and one hospital in North Carolina. In Virginia, Sentara has residency partnerships with several academic institutions, including Virginia Health Sciences and Old Dominion University.
"We have partnered with medical schools for residency slot increases and are working on several specialty programs and primary care programs, which includes a neurology program that we started this year at Sentara Norfolk General Hospital," Hooper says. "We also have approval to start a cardiology fellowship program at that hospital."
Sentara is recruiting for an internal medicine program director to work toward creating an internal medicine program in the Williamsburg, Virginia, area. The health system is expanding the rural track primary care program at Sentara Albemarle Medical Center in North Carolina. At Sentara Northern Virginia Medical Center, the health system has approval to start an internal medicine residency program and hopes to start other residency programs.
Hooper and other executives at Sentara are working closely with their academic counterparts to boost the number of residents at the health system.
"We meet with officials at Virginia Health Sciences and Old Dominion University to make sure that we are aligned with our needs in terms of training facilities and training opportunities for their students," Hooper says.
Boosting preventive care
Hooper says Sentara is using population health tools to close preventive care gaps for patients, including embedded screening processes in the health system's electronic medical record that look for the care needs of patients automatically.
"Whether it is in the inpatient setting or ambulatory clinic setting, patients are automatically assessed for gaps in their population health needs such as colon cancer screening and A1C checks," Hooper says. "There are processes in place to alert physicians and other care team members about these gaps."
Once a care gap has been identified, Sentara has processes in place to intervene.
"We have resources in place such as care managers and automatic scheduling tools in the electronic medical record to make sure that once patients have an identified gap, we can set them up in the outpatient setting with the right services to close that gap," Hooper says. "We have tools and personnel in place to make sure gaps get closed at the population-health level."
Since Sentara has put care gap closure processes in place, the health system has seen significant improvement from a population health standpoint in areas such as hypertension screening, hypertension control, A1C checks, and colon cancer screening, according to Hooper.
While individual interventions for residents such as resiliency initiatives are important, HCA Healthcare believes creating a supportive workplace environment is crucial.
At health systems and hospitals, burnout among physicians and residents is a national problem.
To combat burnout among residents, HCA Healthcare is training clinical leaders and medical faculty to create a supportive workplace environment for the health system’s residents.
In this episode of HL Shorts, Gregory Guldner, MD, vice president of academic affairs at HCA Healthcare, shares the health system's unique perspective on resident well-being and burnout. View the video below. Click here to read the accompanying HealthLeaders story.
Sidney "Beau" Raymond, MD, is CMO of Ochsner Health Network. Photo courtesy of Ochsner Health.
Noah Pores, MD, is medical director of the virtual emergency department at Ochsner Health. Photo courtesy of Ochsner Health.
Lisa Birdsall Fort, MD, is system medical director of quality for emergency services at Ochsner Health. Photo courtesy of Ochsner Health.
Daniel McGovern, MBA, is vice president of finance for Virtua Medical Group. Photo courtesy of Virtua Health.
Tenny Thomas, MD, is president and CMO of Newport Hospital, which is part of Brown University Health. Photo courtesy of Brown University Health.
