Balancing Urban & Rural Healthcare

<p>if I need to micromanage you I don't need you in that job that's not my role to micromanage you I don't have the I don't have the bandwidth to micromanage [Music] people hello everyone this is Cole from the American Journal of healthcare strategy joined by a really special guest Dr Pat rrick Miguel uh Dr Miguel can you please introduce yourself in your current role yeah thanks for having me so uh Patrick Miguel I serve as the chief transformation officer at Community Health Network uh we're based in Indianapolis Indiana midsize Health System uh typically serving people in Central Indiana um we have about 1500 employeed providers and do everything across the board uh except for Pediatrics sub specially in transplants so as the chief transformation officer I have resp responsibility from everything from it and analytics population health value based care uh regulatory reporting clinical uh informatics I have some operational areas as well such as um uh Home Care Hospice pilot of care geriatrics care in the home uh and then I have a new area personalized medicine which is high-risk clinics genetics genomics um high-risk screening and I'm a a family physician still see patients one day a week thank you so much for coming on you have an impressive resume of course you've been with uh Community Health Network cornal Link in about almost 15 years now so that's that's impressive um and then you've worked a lot in informatics clinical transformation of course as well as in strategy and analytics so you have a great kind of overview of everything that's going on um you know Indiana of course there's some more rural areas but as for Indianapolis and the community that you serve are you serving more of the urban Suburban or are you also serving rurals as well you know the nice thing about community health network is we have a mix so we have our East Hospital is really that more urban um near east side of Indianapolis um you know kind of an older area um our South hospital and our North Hospital are more Suburban uh hospitals really kind of verging on uh Urban Suburban um the South one is on the near south side of Indianapolis so it's it has a mix of of suburban and urban uh and then our two hospitals in Anderson and cook are really more rural hospitals and the one in cook is very rural so it that's makes the network very interesting because we have the entire diversity of urban suburban and then rural hospitals um and in the patients that we serve and that that brings all the needs that we have whether it's social determinant or Transportation or other needs across uh how do we deliver services to meet uh the patients that we serve and that's um a big benefit to our audience as well because we have audience members of course primarily urban areas but we're also really trying to do a lot of work with uh Rural and so the fact that you cover that spectrum is important one of the things I I wonder though coming from a transformation perspective does having such a diverse patient population I mean that must make it a challenge when trying to do organization-wide initiatives do you have any tips on how you're able to make manage organization wide initiatives such as maybe an em EHR roll out in the rural areas as well as in the urban areas so I think it's oftentimes when we think about transformation or let's just say new projects or new initiatives we often try and think about this kind of one siiz fits-all and so we're GNA we're going to Pilot it at one location and then we're going to spread it to everywhere and everybody better love it because that's that's what they're getting and I think when you have a mix across Urban suburban and Rural um there's different challenges so I'll take transportation for example we have our own transportation service that's been funded by our foundation some very generous donors uh have funded it over the years so as you think about it Urban transportation and so these are the cars that we provide I should say that we we provide cars we have a couple vans so Urban Transportation Suburban transportation and and Rural Transportation are three completely different problems to solve especially as you're trying to bring people to more tertiary quinary care and so you know we started in the urban because that was the easiest one it's more contained uh we could we could it was a a contained location uh and then we spread it to Suburban and then we spread it to to the rural but we had to solve different problems each time that we did that so I think it's more it's more this continuous learning and mindset uh about how do you roll out these improvements and not just trying to implement a one- siiz fits-all that's really what transformation is about and then how do you identify the differences are you going out in I mean I know you said you're a family physician are you going out and working in these independent communities to kind of see on the ground what the problems are yeah so we work very closely with our clinical and operational leaders throughout the network to understand what problems they trying to solve I mean I always joke and say go into a clinic and just spend 30 seconds and they will be happy to tell you all the problems that they have that they need you to solve I mean that's no shortage of problems that we need to solve or challenges that they are trying to have addressed and so we work very closely with with those I think the fact that I still practice and I practice in that Suburban uh urban area uh on the south side and so the fact that I still practice uh gives me firsthand knowledge of the problems that we're trying to solve or that we need to solve when it comes to to clinical practice uh historically I've practiced in rural areas and so I understand some of those so it's it's a combination It's a combination of our informatics team our clinical and operational leadership team or or Frontline team um and then it's really a group effort about the problems that we need to solve one of the questions that I've been wondering because uh you have this this great overview and you're working with the individuals is when it comes to population Health Management would you say you know it comes to Urban versus rural with population Health Management um is rural more challenging or is it just a different set of problems I think it's a little bit of both I think it's certainly a different set of problems uh I think there's um I don't know that it's NE well I take that back I don't know that it's necessarily more challenging I think it's just a different set of problems I ask that just because you know in Philadelphia here we have of course a very Urban environment in Center City Philadelphia but it drops off fairly quickly after and you get in you know within the same region into some very rural areas and it poses the question of you know do we see sometimes I guess what I'm asking is what's the benefit of having such a large institution like yourself covering multiple areas it does it help with enies across rural and urban and also how do you form those synergies right because at one time I'm assuming there was some separate systems and then now they've merged together so how do you get those to work to benefit each other uh to to take care of those patients when they need the higher Acuity Services that's one problem to solve the second problem is um again there's services that we can provide to those rural areas I'm thinking about technology now technology that in a historical setting uh when they're independent they would never be able to afford the infrastructure some of those other tools and so we can deliver those Services uh because of the economies of scale and I think that's the so again I I I take back what I said that I think I I I don't know that it's necessarily more complex I think it's just different sets of problems we have some of those same problems to solve uh in the urban areas as well um but again it's just a different set of problems a lot of people worry about um what what's happening with the Walmart health and other inst you know organizations where in retail right Walmart would move into a town and it would disrupt a lot of the local retail and then when they leave there'd be a hole that's hard to to fix and so as a lot of these rural systems become part of larger primarily Urban based systems there's some concern about that happening again where do you think we're heading in the future and you know when you think about tele medicine and Ai and all these different things usually we are seeing it first in urban areas but when it comes to Tele medicine we're seeing it first in the rural areas what do you think the future looks like and then also how does that tie into that concern of you know these healthc care deserts forming yeah I think it's I think tele medicine can absolutely serve a purpose and it has serve a purpose even prior to the pandemic for Specialty Care you know you think about Tel neurology has been on been around for a long time tell a stroke um we're partnering with some of the rural locations for things like infectious disease and and endocrinology and some of those types of Specialties that are more amable to uh tele medicine now things like surgery and and OBGYN you those need to be in person so I think it's incumbent upon the system to really help retain the the culture of that rural location and so we have a uniform culture across our organization but I would definitely say our more rural Hospital the two rural hospitals have their own identity because those people live in that Community they work in that Community um I I think it it has a unique I uh culture and identity and I think that's important to what you're talking about I don't know that um at least in our area that we've seen this um consolidation and removal of services um to to to result in a healthc care desert I think it's actually the opposite where it builds that connection to retain some services that may have been um have become healthc care deserts if there wasn't a a broader partnership and again Partnerships can occur on many different levels it could be just a shared services it could be a formal merger and acquisition uh it could just be a clinical partnership so you're seeing is these Partnerships are increasing the availability which is excellent so part of that though that goes down to that that independent culture is there any friction that occurs because of that um it seems like it would be be challenging at some point right when you have different cultures working together is there any friction that goes on there's always friction when you're when you're bringing cultures together but I think that's where leadership comes in um I think that's where um change management comes in to just you know work through the changes and understanding of the different cultures and and and it takes time I I think these things these things occur over time and they evolve um but I think that's again I think that's where solid leadership um and some of the solid change man management principles are very important are there any principles specifically that have been valuable to you as as the chief transformation officer that maybe you could give some of the younger early careerists to use yeah first and foremost is listening I think you have to listen you have to understand um I think that often times we go in and we think we know the answers um and we may not and so it starts with listening um the flip side is the flip side of that is often times we can listen to the point of being frozen in decision making so there has to be a little bit of courage to say we've listened and and you know we've heard everybody Fair process our organization is is a big proponent of fair process to say we're going to hear everybody we're going to get everybody's input that possibly can and at the end of the day this is going to be the the the team or the person or the the committee that makes the decision and I think when you can go into some of these change managements with Fair process so that's transparent um that can alleviate a lot of problems down the line transparency is this is the third one I would say U being transparent in transparent in the initiatives transparent in communic and just honesty when you came aboard as the chief transformation officer have you ever had to struggle with or or maybe you haven't uh and just just any advice in general but um you it's it's tough because you're expected to really transform right and so you are the chief CH change agent really of the organization um but sometimes even among the SE Suite or among you know high level managers uh there is still some resistance to change because people do not like change um so I think the first question is have you always liked change yourself uh and if not is there anything that got you to the level where you are now in this position where you're always looking for change I don't know that I've always liked change I think that I've um always had this desire to make things better so my wife has the saying of uh always be better and it's not that's not meant to be in a competitive I'm better than you or I'm I'm going to beat you type of way it's just always always be you can always be better you can always learn more you can always be the bigger person you can always listen more you can always be more understanding you know just always be on better so I've always even going back to when I was in high school college and med school always had this just desire to how can we make things better how can we make the system better how can we make make patient care more efficient how can we make the experience better and I think that has led me down this journey I don't have a technology background I don't have a data and analytics background I don't have a process Improvement background um but it's it's this um ever burning desire to say we can make things better we can make it better for patients we can make it better for caregivers we can make it better for the system some organizations struggle with that a lot lot would you think there are ways to get an organization to change their culture even if there are only one or two people kind of at the top who share that mindset or do you think that it's best to seek out organizations that already have that mindset I hope you you know I hope that makes sense I I think I understand the question I I think what you have to do is it all change starts with somebody right there's there's the butterfly effect there's the Tipping Point whatever you want to use but I think that um you got to have the right ingredients uh we have support from the leadership I report to the CEO I sit on the executive committee so I think you have to have change agents at a high enough level in the organization to really drive and impact change I think that's one problem that a lot of organizations do they bury the change agents five levels down and and those people just get burned out and frustrated and end up ultimately leaving so I think your organizational structured matters and um I think that having the right uh ingredients also matters to be able to drive some of that change uh as well so you know I I I don't know that every organization has that culture out of the gate but I do think every organization can have that culture out of the gate I don't think people go into Healthcare I I think people go into healthcare because they want to help people they want to make people better they have this desire for the better for for the better good and I think you can leverage a lot of that and then on that note about how it's it is possible of course um for organizations like you're saying to have that out of the gate was your role the chief transformation officer position is that a new position for the system or is that existed for a while no it's a new position so I I took the role in 20 um I took the role in 2021 2022 it was really more of a title change I had a lot of I was previously the chief analytics officer but...