Key Takeaways
- Successful healthcare integration requires balancing centralized clinical protocols with local autonomy to effectively address unique social determinants of health across diverse regions.
Over the last decade, the healthcare industry has experienced an unprecedented series of mergers, acquisitions, and strategic alliances. Leaders in the field must grapple not only with the clinical aspects of patient care but also with complex operational, financial, and cultural challenges. No one understands this better than Mayank Shah, MD, MBA, FAAFP, Vice President and Chief Medical Officer (CMO) at Advocate Condell Medical Center in Libertyville, Illinois. As one of the prominent chief medical officers in the region, Dr. Shah's experience spanning multiple healthcare systems and even time on the payer side offers a unique perspective on what is a CMO in healthcare and how integrated healthcare can better serve patients, providers, and communities at large. His insights shed light on the evolving role of CMO in medical terms, the complexities of modern healthcare leadership, and the importance of medical executive roles in shaping the future of healthcare delivery.
Dr. Shah's current role places him at the helm of a busy, 275-bed community-based hospital that also functions as a Level 1 trauma center—"the only one in the Lake County area in Illinois," as he points out. This distinction means Advocate Condell sees a high volume of emergency and critical care cases, requiring robust clinical governance, hospital administration systems, and a strong focus on safety culture.
Given the hospital's extensive reach—covering large swaths of both suburban and semi-rural regions—diversity is the rule rather than the exception. Condell's patient population comes from a range of socioeconomic and cultural backgrounds, each with distinct healthcare needs. "There is such a diversity of different communities within the area," Dr. Shah says, noting that addressing the wide array of medical and social needs is both a privilege and a challenge for healthcare executives like himself. This diversity also underscores the importance of conflict resolution skills and risk assessments in managing such a complex healthcare environment.
Advocate Condell is part of Advocate Health, the result of multiple mergers, including a significant one with Advocate Aurora Health in Wisconsin and, more recently, with Atrium Health in the Southeast. These mergers extend Advocate's reach beyond the Midwest into North Carolina, Georgia, and other regions, presenting unique challenges in healthcare strategy and integration. The complexity of these mergers highlights the critical chief medical officer responsibilities in navigating organizational changes while maintaining high-quality patient care.
In an era where "cybersecurity… is top of mind for every healthcare system," the technical effort required to integrate electronic medical records, telehealth capabilities, and operational platforms is immense. The implementation of healthcare technology and adherence to healthcare policy are crucial aspects of this integration process. Yet Dr. Shah believes that the lessons learned from earlier mergers have positioned Advocate Health to better navigate new partnerships:
One of the critical points Dr. Shah emphasizes is that a standardized approach to care can only go so far when each region exhibits different social determinants of health. While the clinical manifestation of illnesses like heart failure may be similar from Chicago to Charlotte, the root causes—and potential barriers to treatment—vary significantly. This understanding is crucial for effective population health management and patient-centered care, and it underscores the importance of evidence-based practices in addressing diverse healthcare needs.
In a large, multi-state system, leaders must balance the efficiency benefits of centralized protocols with the local autonomy necessary to address unique community needs. Dr. Shah underscores that "variation in markets" is often a product of underlying social factors such as food security, housing, and loneliness, which require localized solutions. This approach is essential for improving overall quality of care and ensuring patient safety across diverse populations.
Throughout his career, Dr. Shah has observed a major shift in the responsibilities and skill set required for the Chief Medical Officer role. Today's CMO is no longer focused solely on clinical outcomes; they must also consider financial constraints, care coordination, and, most importantly, organizational culture. This evolution reflects the changing landscape of healthcare delivery and the increasing importance of strategic planning in healthcare organizations.
Dr. Shah cites an increased emphasis on team-based approaches and innovative thinking. Rather than depending solely on expanding clinical protocols or adding more consults and medications, CMOs today are called upon to ask: "What happens when I don't have the resources?" and "How do I think about this differently?" Sustainable healthcare models rely on thoughtful utilization of resources, community partnerships, and proactive engagement with both staff and patients. This approach requires a blend of clinical expertise and administrative management skills, highlighting the importance of understanding how to become chief medical officer and the necessary chief medical officer qualifications.
One of the recurring themes in Dr. Shah's vision for effective healthcare integration is the importance of communication and collaboration.
Internally, Advocate Health relies on regular CMO meetings to align clinical protocols, share best practices, and problem-solve across states. This approach enhances physician engagement and promotes a culture of continuous improvement. Dr. Shah highlights how, in moments of crisis—like a shortage in IV fluids due to natural disasters—collaboration even with competitors can become a lifeline.
The lesson here is clear: when it comes to patient lives, there is far more to be gained from shared innovation than from siloed thinking. This collaborative approach is essential for improving organizational performance and addressing complex healthcare challenges. It also emphasizes the importance of effective leadership and conflict resolution skills in managing healthcare teams and ensuring physician satisfaction.
A frequent concern among healthcare professionals is how to stay innovative when resources are already stretched thin. Dr. Shah acknowledges this tension, recognizing the risk of burnout and discouragement in under-resourced settings. Yet, he encourages leaders at every level to focus on purpose and process, rather than being solely metrics driven.
He encourages hospitals to look beyond immediate finances and facility walls, exploring "foundation and fundraising opportunities," partnerships with community organizations, and even philanthropic alliances that can bolster care delivery. "Don't ever be afraid to reach out and ask for collaboration," Dr. Shah advises. "There's tremendous opportunity for us to do that in healthcare." This approach aligns with the broader goals of healthcare economics and sustainable clinical operations, and it underscores the importance of continuous education and adaptation in the healthcare field.
The ultimate goal, Dr. Shah says, is to "redefine care to look at how we incorporate more thoughtfulness and strategy around social determinants of health." By standardizing core clinical practices—while also tailoring programs to the local fabric of each community—health systems like Advocate Health can ensure a "cost-effective, sustainable approach" that benefits patients far into the future.
He sums it up best when he underscores that healthcare integration is not merely about assembling larger networks or leveraging economies of scale; it is about creating cohesive care teams that talk to one another, share resources, and engage local communities. "When people are putting their lives in your hand," Dr. Shah says, "they really want us to see more collaborative."
As healthcare continues to evolve, leaders who can navigate the complexities of multi-state integrations and maintain a patient-centric focus will help shape a more effective, equitable system. Dr. Shah's experiences—spanning clinical, administrative, and payer worlds—demonstrate that communication, culture, and innovation are the three pillars on which successful integration is built
It will take ongoing commitment, openness to collaboration (even with competitors), and thoughtful attention to the local nuances of social determinants of health. But with leaders like Dr. Shah at the helm, and a vision anchored in both clinical excellence and community-minded collaboration, healthcare systems can rise to meet the challenges of our time—and the generations to come. This approach not only enhances patient safety and quality of care but also sets a new standard for healthcare leadership in the 21st century, emphasizing the importance of incident reporting, evidence-based practices, and effective management of clinical staff to achieve optimal outcomes.
<p>if you ask patients what is the f one thing that you want out of your health care System they'll say I want everyone to talk to each other right and this so this is so important that that we buil that right off the bat as our culture and I think that can truly set us up for [Music] Success hello everyone this is Cole from the American Journal ofal Healthcare strategy joined by a really special guest today uh Dr Shaw can you please introduce yourself in your current role uh thank you so much cole for the opportunity my name is maak sha I serve as the vice president and chief medical officer for Advocate Condell Medical Center it's a community- based Hospital uh that's in the Libertyville Illinois area so north of Chicago uh we are about a 275 bed hospital a level one trauma center the only one in the Lake County area in in Illinois and uh very very busy place for sure so when when you say the only one in the area how far is the next level one Trauma Center about 18 miles okay so that's a ways in in that area for traffic and everything that's to the south of us and to the north of us we are about 40 miles away from the nearest including crossing over to the Wisconsin border so um it's we have a pretty broad geography that we cover within the Lake County that uh you know our level one Trauma Center covers so that means that you see a lot of kind of urgency going on in your Ed this is not a a low utilized Ed from what I'm assuming oh no it is not low utilized at all we our Ed is always always extremely busy and uh the hospital as well uh you know we have had average occupancies of anywhere from 260 to 280 uh on a regular basis over the last several months so um I I think it's a very busy place there's a huge need for service in the community and uh the cool thing about Lake county is that there is such a diversity of different communities uh that exist within the area and so I think uh serving that patient population in that Community has been uh one of the biggest privilege as well as a challenge for K one of the questions I have for you is is because you've been uh there about a year or so right so was was this post the acquisition or post kind of the the series of mergers that they went in uh with with Advocate or were you still kind of coming in at the tail end of that H so you know I my journey has been uh fairly interesting because I trained at ad within the advocate system so I was at Advocate Lutheran General Hospital that's where I did my training and then I stayed on his faculty for about 11 years then I jump ship and went to a different Healthcare System uh to a Catholic non-for-profit healthcare system in the Illinois Market at the time then I uh kind of adventured out into the payer world and I was part of siga and then santine for a while and then I came back to advocate so um I'll say that I have been with Advocate through uh multiple Journeys and multiple mergers and Acquisitions uh most recently when I joined condal it was after the merger with Atrium in the Southeast and after it had developed a national footprint beyond the mid west region and so yes um you know I I was part of a lot of that Synergy and transitions that occurred uh through that uh transition process what are the challenges that you're facing kind of post transition I I've spoken with a lot of people at at Advocate kind of from an Enterprise level and they say that their one of their biggest challenges is that it's geographically spread out and so we have to think about like weird it scenarios I was speaking with one of and they were saying that they're trying to figure out connectivity between a campus you know all the way in in Charlotte or Georgia with Chicago and how sometimes the internet speeds or Internet you know lines will go down and all these like different problems but what are you facing kind of local to where you're at so I think you know thinking from an Enterprise mind frame I'll tell you that cyber security over the last uh couple years has been on the top of Mind of every Health Care system in the country and and absolutely what you're referring to uh the undercurrent of all of those discussion has been how do we create more cyber secure environment when it comes to healthcare and so that has definitely been part of the consideration I think one of the key challenges when Healthcare Systems come together is that we have our own technology infrastructure that we have built over the years and as you merge how do you align how do you create communication Pathways and how do you share best practices and instances so that there's uniformity in the care delivery so I'll give you an example when we when Advocate Health which is the Illinois part merged with Wisconsin Aurora Healthcare we were existed on two different servers and it took us almost three years to technologically integrate so that we can share information across the board um luckily this time it you know what we've learned our lessons through that transition and acquisition process we we absolutely learned our you know how to expedite and how to far better than what we did in the past uh but I think you know those are some challenges that we continuously have in the market to really think about how do we first of all um you know think of more integrative process so that we could Ben all benefit as a system from some of the changes interventions that we're making we can also learn from each other on the best practices and then we can also share resources across the you know the state lines and I think those are some challenges that we continue to work through as we integrate more effectively and efficiently just kind of like the next question I had was there's a lot of CMOS at this point within the system because it's s you there's so many hospitals um and even with Hospital consolidation we still need a lot of hospitals and and then therefore a lot of CMOS and you're overseeing like we had mentioned before you got started 1400 people that's a that's a lot of people and a lot of patients um what does the collaboration look like between CMOS and Hospital leaders in in Charlotte for example or in Georgia I think it's in makon is where the other Atrium campus is uh and then also in Wisconsin in Illinois are you all do you all know each other yet are you still meeting each other what does that look like um great question and I think part of this is what we had originally set up as a region so uh initially when we came together with the southeast just because of this integration effort of bringing everything together Advocate heal was already on a journey with integration with the wi market so it was very easy to think of us as two distinct regions the Midwest region which included Illinois Wisconsin some sites in Michigan and then uh our Southeast partners and so those were the two geographic regions that were divided and then we had leadership teams within each of the Departments and I think uh initial learning part of the integration was really learning about the leadership in each of those areas coming together learning about our best practices and then also strategically thinking about how do we um collaborate with each other in a way to bring uh programs and and patient care models uh that are more aligned with what the market is doing and how can we redefine care which is kind of the value uh and mission of what Advocate has set out to do in the next few years and so I think uh really the structures were already set up and so in the Midwest region the CMOS have a regular meeting where we all come together we talk about uh issues concerned as well as strategic approaches to tackling our Market as well as some of the key outcomes in the markets again focusing on quality and safety uh for for the patients and communities that we serve and then uh learning that from the southeast has been what are some of the challenges we have then how do we collaborate across the bord to the southeast to learn what have they done in the past what are some best practices and then vice versa sharing some of ours along the way so that we can now continue to drive those best practi is locally as a physician with with experience kind of geographically across different markets one of the questions I have is are the conditions you're treating and also I'm thinking about like comorbidities different in different markets and is that why we need to think about how to kind of segment while also tying together at the same time oh absolutely so you know even though the medical conditions may be the same across the board and across the country and I even know this from my previous work at you know being in various markets across the country heart failure looks and presents the same way in Illinois Wisconsin Georgia North Carolina however the contributors to that heart failure may be very different in each of the markets the challenges that our patients with heart failure face may be very different in each one of those markets in each of the local areas I can tell you there's variation even in the state of Illinois if you live in Cook County and if you live in the south side of Chicago there's extremely different challenges than up north you know where kandal is located so I think um it and and we know now in healthc care that about 80% of your health outcome is a result of what we call social determinance of health so not directly related to your genetics not directly related to your your condition or care that you get but everything around it right whe are you lonely do you have Financial Security do you have food security do you have uh housing all of those things contribute to your health outcome and those nuances of those determinants are very local to the environment where you live and so this is where the variation comes in so yes we could have a standard way that we manage heart failure and you have organizations like Kaiser that are really doing a great job of that where they're standardizing their approach across no matter where you go in Kaiser you're going to get the same level of clinical care but despite that you see various different outcomes in different markets and the reason for that different outcome is really the social determinants of health so what Advocate Condell and what what Advocate Health is committed to doing is not only looking at the clinical outcome in the clinical care but we're redefining care to look at how do we incorporate more thoughtfulness and strategy around social determinance of Health our ultimate goal is to get to the highest quality outcome and the EST outcome we can get for all of our patients but it's not going to just be around standardizing clinical care it's truly paying attention to those social determinants and all of the other caveats that go with that Health Care outcome Family Support Dynamics Community Support all of that is so integral to the success of the outcome in in in a healthcare recovery and so how do we pay more attention to that how do we build systems and infrastructures to really drive that is the key objective that Advocates taken on I think that's a really important point because we we need this or I'm actually doing a research project right now at the University for this is economy of scales helping and we know that a lot of time it's helping the financial bottom line and a lot of times it is improving quality metrics as a whole but I I think we need that approach where we're standardizing the quality of our care and we're standardizing you know our finances so that we're able to potentially help different parts of the country different parts of even in our city that weren't able to get help before but that's really important that we keep track of those kind of cultural differences especially in preventative care I feel like because I know from my experience I went to college out in Charlotte for a little bit now I live in Philly the types of fast food that are available are different the types of urban environment is also different in Charlotte you know it's kind of a downtown that you drive to for events you usually drive to a hospital here in Philly if you're going to go to a hospital usually you're going to want to take transit or you're going to you know I see people using Ubers for ambulances quite frequently and so it's a different environment and then that's going to be different conditions that's so so important but one of the challenges I have on that is what work is required on your part as a CMO to make sure that that that your population is being cared for especially since you have lived in different Geographic areas you've been exposed to different Geographic areas what are you doing to make sure that that your care at the hospital is being tailored towards that population a great question again and I and I think you know the the the role of a CMO has changed drastically over the last decade and I can tell you that having lived through this experience and various organizations and having really had different roles throughout in different models of care in the past I can say that there was a a significant clinical Focus that the CMOS had we were had accountability for the clinical care delivery part and clinical outcomes I don't think that's the case anymore I I I don't think we can work in a silo just to focus on the clinical care ignoring the financial aspect ignoring the social aspect of care delary the community engagement and collaboration now creating that team-based approach I think culture as you know has become a integral part of success of any organization and specifically in healthcare I think the having the right culture is so important to driving your strategy and driving that optimized outcome uh having CMOS pay attention to the culture in the organization is absolutely important it's a critical skill that allows for a successful outcome at the end of the day so that is one skill that I think is critically important as a CMO that in the past we probably didn't get trained or didn't really focus so much on um second is really thinking outside of the box I think we are um so much solution oriented as providers as Physicians that you're constantly focusing on coming up with how do I treat this the best way possible what can I do what tools do I have available but also thinking about when I don't have any tools how how would I think about this differently and even when I have tools at my disposal what happens when those tools run out when I don't have resources to be able to sustain and afford that and I think that type of thinking is what will allow us to move forward in healthcare in the past I'll give you an example whenever we had a patient with severe illness our our our idea was let's throw in as many consults as we can let's throw in as many medications as we can at them to see if we can get them better we see if we can improve their quality of life that is not a sustainable long-term solution right but what else do we need to do to provide that holistic care to your point if the issue is you're living in North Carolina and you don't have access to fresh food and now I'm going to have you manage diabetes and teach you about fresh food that effort is fruitless right you're don't have access to that what what are you going to do with that information there's no you're not going to impact the outcome so how do I think strategically and create and innovate in this space to help you achieve success with the goals that I need to set with with you together and that's the level of thinking that I think we need to evolve into whether you're CMO whether you're at Frontline delivering care I think P thinking outside of the box is more and more of the requir in healthcare today than it has ever been in the past in the past we we were focused on the medical knowledge expanding so quickly keeping up with that medical information how do I have the right treatment protocols the right treatment opportunities and making sure that I'm delivering the right clinical outcome now it's more about is my care comprehensive am I thinking holistically about the care model and what else could impact the outcome here that I'm not thinking through it's important that you mention that as well it's it's not like everybody every body was sitting on their hands for the past hundred years right everybody was extremely busy for the past hundred years but the issue is that you know a 100 years ago you know penicillin was just gaining F right so we we were kind of living in in pretty dark times um you I have a great book I like to leave out and it's kind of the history a photo history of surgery and it covers all you know paintings of all these different surgeries I mean people are often surprised at kind of how brutalist some things look in as early as the 1900s right so now that that has changed a lot like you said the focus is changing but here's where uh and I I know the time is running short so I'll ask you kind of for one of your last pieces of advice but it's a hard one and it's that sometimes when we are working for an organization as an employee and we're told we don't have the resources that we used to have so we need to come up with innovative ways it can kind of just be like wow I'm just being given more work and I've seen some team members including myself sometimes just resign ourselves to this situation and get discouraged and say well if they don't want to give us the resources then you know that's their problem I supposed to do this yeah right exactly and I so like I said I sympathize with that but because I've been there there's the other side of the coin which is you don't want to drive people too hard where they're burning out or they're discouraged uh on the other side of things and so how do you have any tips on how we can manage that middle ground where our employees are motivated to innovate they feel safe to innovate but they're not burnt out yeah this is an issue in healthcare that we're all struggling with these days right and and as much as we'd love to have unlimited resources the reality is that we are going to face a challenge in the next decade in the next two decades where we're not going to have unlimited resources to throw at our patients and to take care of the communities we have an aging population we have enormous tax on our healthare system already there's a provider shortages in multiple Specialties and so how do we manage that going forward and not um make people burn out and at the same time take care of the needs of the community my advice is is twofold first and foremost I think it's really important that we have our own sense of purpose right and we just talked about this as a team I think a lot of times we get so focused on metrics and outcomes like we say oh my God I got to achieve this success with readmission rate or I got to get this number down we forget the process in it self right we we measure our success based on the outcomes of those metrics that is not our true success the true success is the effort that we put behind those metrics what was our thinking what innovation did we come up with did we think outside of the box did we come up with new ideas and New Opportunities did we come up with a new vision right all of those nuances really contribute to that culture of healthcare that I was speaking about earlier and I think that that is the true success in healthcare and I think if we can capture that we'll have great success in thinking through and not getting burned out through this process it's truly about what can I do with what I have we are this the condition right now and the situation right now is preparing us really well for the future when we are going to have limited resources and we're going to have to think outside the box but if we train our mind to think this way we'll get reward out of the process itself rather than the end outcome and the end outcome will automatically come our way and I think it'll come out our way in a very smart way because not only will we get the outcome but we'll get it in a cost effective way that doesn't burden our economy so and it'll be sustainable for future Generations right which is Absolut where we're not at right now absolutely and that that should be our goal to think about is not just how do I fix this now but how do I sustain this for generations to come can you give us maybe a first step that fellow mod can take and I I think maybe on a smaller end as well maybe a less resourced end already because I know what some people say you know rural hospitals is when I talk to them is they're like I'm already so underresourced you want me to to look at ways to use less resources but what is a first step that they can take if they're watching this right now they're planning out you know for 2025 what initiatives they're going to take on what would be the first thing first and foremost thing that I'll say and I've done this in every single role I've had as a CMO is understand your Market understand every nuances of the population the community that you serve and the resources that you have available oftentimes when we think about resources we're thinking about our immediate workspace we're thinking about my hospital my community but there are resources beyond that that can help us tap into some of the creative ways to think through this issue there are U you know foundation and fundraising opportunities that may get us over hum when especially when we're stuck there may be philanthropic efforts that we can make there may be alliances that you can create a lot of times we think of competition as someone we can't share anything with I I'll give you a great example we had an IV fluid shortage recently you know with the backer planned getting flooded in North Carolina I'm sure everyone got affected by that our first step that we took is we came together with our competitors in the market and we said how do we solve this together and we came up with some great ideas together on how we can leverage each other our skills or experience to really bring those Solutions together to take care of the community that we serve now had we stayed in a competitive mode we probably wouldn't have accomplished that together right but I think this is where we need to look Beyond this is what I mean about thinking about your and studying your Market in a deep way so that you know what your resources are you know who your collaborators are and don't be ever be afraid to reach out and ask for that collaboration take that step to collaborate and I think there's tremendous opportunity for us to do that in healthcare I I have seen firsthand and I'm you've seen it probably many more times than me that those who share and work together I mean just like your example just now they usually succeed and those who don't sometimes uh do succeed still but usually it's much more costly and it also it harms reputation no nobody in the public wants to see hospitals competing that is that is a figment of our maybe our imaginations a little bit right so they want to see us partner that's right when people are putting their lives in your hand they really want us to see more collaborative like this is so important that that we build success thank you so much Dr Shaw that's an awesome place to leave off on so I'll I'll uh end it there but I hope we can have you back on again in the future I would love to be part of this and thank you so much cole for giving me this opportunity to talk</p>
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