Presbyterian Healthcare Services CMO Talks Strategy, Patient Safety, and Workforce
By Christopher Cheney
One of the biggest challenges of being a chief medical officer is balancing day-to-day responsibilities with strategic planning, says Jason Mitchell, MD, SVP and chief medical and clinical transformation officer at Presbyterian Healthcare Services (PHS).
Mitchell leads more than 1,100 physicians and advanced practice clinicians. He also provides clinical oversight for the Albuquerque, New Mexico—based health system’s medical staff operations at nine hospitals.
HealthLeaders recently talked with him about a range of topics, including clinical leadership at PHS, healthcare worker burnout, patient safety at PHS, and workforce shortages. The following transcript of that conversation has been edited for clarity and brevity.
HealthLeaders: What are the primary challenges of serving as CMO of PHS?
Jason Mitchell: The biggest challenge is thinking about the day-to-day things you need to solve and improve, then be able to elevate and focus on strategy, so that you are looking out six months, one year, and three years. You need to be building the future for the organization. It’s a big challenge because it is easy to get lost in the daily complexities and lose sight of how you get the organization to where it needs to be a couple of years out.
Fortunately, I play a large role in the strategy of the organization. I spend a lot of time bringing together clinical and administrative teams to focus on the future.
HL: How do you manage to get past the daily work and focus on strategy?
Mitchell: I have great partners in leadership who work with me on meeting this challenge. We think about what we must do and what we must transform so that three years out, we are achieving what we aspire to achieve. We spend time looking at the environment both nationally and locally, reflecting on what we want to accomplish as an organization for our community and the people we serve, and thinking about the key themes for success. Then, we go through a disciplined process to determine what work we need to do, what assets we need to create, and what are the milestones.
We start at a high level, then we engage frontline clinicians and workforce in the design process, so we design a future together. It is very deliberate.
HL: What is the status of healthcare worker burnout at PHS?
Mitchell: We are like everyone else in the country. Healthcare is hard. Healthcare was hard before the coronavirus pandemic. The pandemic has certainly changed a lot—it has changed the workforce, it has changed the support staff, it has changed clinical expectations, and many people got exhausted. We are not immune to any of that.
As you talk to our clinicians, we are a good team. Our medical staff is solid. We have a lot of tired people, but we have done a lot to support them. We did work on the physician and advanced practice clinician experience before the pandemic started, so we already had tools, processes, and teams in place to support clinicians before the pandemic began, which has helped us through the pandemic.
HL: Give a couple of examples of initiatives that you have in place to address clinician burnout.
Mitchell: One of the programs we have focused on intensely is called Relations. It is a half-day course that we have been doing for about four years. You would think in our professional education that they would teach us to be great communicators, but they do not necessarily do that. Relations is about learning to reflectively listen, to read body language, to understand the biases you bring to the table, and to practice your skills. We do role-playing. So, people can practice their skills such as reflective listening, and it has been an amazing experience. It helps in clinic and in our personal lives because it helps you listen better, which makes communication more effective and efficient. Relations helps you interact better with patients and colleagues.
Another program we have focused on is called Reset, which involves self-exploration as an individual. Again, if you think about our professional education, the amount of time for ourselves is limited. You just go, go, go through your training in medical school and residency, then you start practicing medicine and you just keep going. Reset is a multiday experience in small groups that is structured and gives you time to reflect and work on yourself. We have found that Reset has been transformative for people. It has prolonged careers for people who have been thinking about leaving medicine. It has kept people in the organization who were exhausted. And it has helped people be happy in their home lives as well.
HL: What are the primary elements of patient safety at PHS?
Mitchell: There are several key parts of patient safety at our health system. There is high reliability. When systems are reliant on the efforts of people, they are more successful when the high reliability processes are working.
Another piece is psychological safety and just culture. Your workforce must feel safe to report errors and to engage in process improvement. You also need to have a just culture, which is not punitive. The focus needs to be on root causes of adverse events and how you fix them.
The other piece is an absolute unwillingness to accept anything but zero harm. We have what we call our Journey to Zero Preventable Harm. We have several metrics, and we focus on them. On the executive team and the frontline, we look at those metrics all the time, and we do not just focus on Centers for Medicare & Medicaid Services metrics. There are a lot of hospital-based safety metrics, which are focused on Medicare fee-for-service patients, but they do not include Medicare Advantage, healthy adult, pediatric, or obstetrics patients. When we think about safety, it is for our entire patient population.
HL: What are the primary metrics you are following when it comes to patient safety?
Mitchell: There are several standard metrics for patient safety that we follow. We look at hospital-acquired infections such as central line–associated infections and urinary tract infections. Then we look at categories of never events such as falls with injury, retained foreign bodies, and unexpected mortality. For our Journey to Zero Preventable Harm, we have 14 metrics that fall into that initiative that we monitor on a regular basis that are standard metrics similar to the PSI 90.
HL: What are the primary efforts you have in place to address workforce shortages?
Mitchell: There are three levers—recruitment, retention, and pipeline development.
In recruitment, we focus on the culture of the organization. We are not-for-profit and based on helping people and doing the right thing. We have a great culture, and that helps us for recruitment. We recognize that many of our clinicians such as nurses want flexible schedules—they do not want three 12-hour shifts. They may want 8-hour shifts. We think about what the workforce needs for people to thrive—what does the work need to look like?
We make sure we pay based on the market or better than the market. We have competitive benefits. However, it comes back to being not-for-profit and community-based. We are an organization that people can be proud to be a part of, and that supports our recruitment.
With retention, we have a lot of focus on how our workforce thrives. We also focus on development. So, we do significant management and leadership development, whether that is for administrators or clinicians. We have many opportunities for learning and advancement because we want people to continue to grow.
We support our staff. We have Code Lavender. Frequently, bad things happen in hospitals, and as healthcare providers it hurts. We have processes in place where if something bad happens in the emergency department or another unit, we will bring in a team of people. We will bring in food. We bring in support and are there for staff members.
We have strategic plans for the workforce whether it is doctors, advanced practice clinicians, or nurses. We want to know what their needs are and make sure that we are providing for those needs. So, there is a lot of intentionality.
Pipeline development is important. We spend a lot of time out in the community. Although we are not an academic organization, we have about 2,000 students who rotate through our organization every year. We are the second largest provider of clinical rotations in New Mexico behind the University of New Mexico. Those rotations include physical therapy, respiratory therapy, doctors, nurses, physician assistants, and pharmacists. Bringing people into our organization, building relationships, and letting students learn about us is a great pipeline.
We also partner with the university and Central New Mexico Community College. If students want to get into healthcare, we want to make it easy for them to join us.
Christopher Cheney is the senior clinical care editor at HealthLeaders.