Michele Arnold, MD, MBA, recently assumed the role of Vice President and Chief Medical Officer at St. Mary’s. Previously, she served as Chief Medical Officer of Swedish Medical Center in Issaquah, Washington.
During his tenure, his focus on growth, transformation and stewardship has led to improved performance results that have endured the impacts of COVID-19. Board certified in Physical Medicine and Rehabilitation and subspecialty board certified in Neuromuscular Medicine, Arnold has held a variety of clinical and management positions in the Swedish Health Services, including Regional Executive Medical Director of Musculoskeletal Service Lines.
As a key member of St. Mary’s leadership, Dr. Arnold will strive to improve the patient and caregiver experience and expand the high-quality, high-value care provided to Grand Junction and surrounding communities. .
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State of the reform: As Chief Medical Officer of St. Mary’s Medical Center, what is your vision for the hospital as the Grand Junction community seeks to recover from the pandemic?
Michele Arnold: “Obviously, the continued care for our sick patients who contract COVID will undoubtedly continue. This will be in conjunction with the many other contagious [and] infectious diseases that we treat regularly. We have learned a lot during COVID and we can take all the lessons and incorporate them into our post-pandemic future. The one that comes to mind most is telehealth and telemedicine, which will continue to be a welcome extension of in-person care. It’s something we’ve been advocating for a long time before COVID. [The pandemic] has really been the accelerator of this positive change for all of us.
The other one that comes to mind is our infection prevention programs. They have become very capable and they will continue to be a resource for the next wave of whatever may come.
The other one I was involved in during COVID was incident command, and our hospital leaders have now become more adept at the incident command structure. We have moved to this mode of continuous preparation. Medical teams have actually really gelled during COVID. Clinicians who have worked together across [the] the dark days of COVID seem to be emerging with this newfound passion and better equipped to coordinate care.
Then the downside is that burnout continues to be an issue and has increased throughout the pandemic. Here in our post-pandemic future, we are grappling with over 50% of clinicians admitting one or more elements of burnout. This is the biggest workforce disruption of my life and staffing will become a priority for years to come. From a social point of view, there is this growing distrust of authority, especially [for] Health care workers. Often people don’t know what or who to believe. And so transparency and integrity will be key to rebuilding that trust. I believe that the place for this to really happen is an individual, patient-to-clinician relationship at the bedside or at the clinic, and it’s actually my greatest hope for the future of our health care lies in that restoring trust, starting with this relationship.
OR: What are the immediate needs of St. Mary’s Medical Center and its patients? How can federal and state reforms meet these needs?
MY : “So speaking of burnout, caregiver wellbeing is really the big answer and remains at the center of healthcare systems. We need to crack down on attrition and turnover. Just today I was at a nurses meeting not an hour ago and I heard stories about silent weaning. Burnout really leads to a lot of dissatisfaction.
Caregiver wellness is going to be a big focus and we have programs here, but I think it’s so universal that it would be really nice to have state and federal support for initiatives well-being of caregivers. We fully support the efforts that continue to ensure the continued protection of our caregivers and we have plenty of resources, but I think it’s still not enough.
Another element concerns reimbursement. There’s this growing mismatch between health care reimbursement and the plain old cost of doing business. Things like durable medical equipment and supplies and labor, they are growing in line with inflation, but even at a faster rate. Meanwhile, reimbursement to health care providers has been steadily declining for more than a decade. There is intense pressure on hospitals to develop efficiencies and reduce costs. So we’re managing the supply chain and we’re trying to improve the productivity of our workforce, but at the end of the day, it comes down to a care overhaul. It’s going to ensure our sustainability and it can be a disruptive place to go.
It’s like trying to build the plane while you fly it, and we’re constrained by various regulatory requirements that sometimes prevent us from being nimble. Efforts to redesign care will be really important. So [there are] our workforce constraints. Here at St. Mary’s, we continue to use placement agencies or travelers to help fill in the gaps, resulting in much higher labor expenses. Recruitment in our community and geography can be very challenging, especially for physicians and advanced practitioners.
Training programs should use predictive modeling to help assess current and future workforce needs, so that we can serve our community, especially around nurses, doctors, therapists, health professionals behavioural, technicians, aides, pharmacy staff and laboratory staff. These were really difficult. Scaling up training programs and then apprenticeship programs might be an option we could explore to help bridge the gaps until these trainees actually enter the workforce.
Then finally, today’s socio-economic challenges come to mind. Fundamentally, patients in our community face increasing social and financial pressures and our aging seniors are therefore particularly vulnerable. They lack adequate support. We have people who don’t have a home to live in, those who are in transitional housing, [and] people with behavioral health issues or substance abuse or addiction. They are our most vulnerable in our community.
Of all the things I could use with a magic wand, regulatory efforts and/or financial incentives that expand the safety net for our most vulnerable, this would be the thing to settle. »
OR: Can you talk about any programs or initiatives that address accessibility and equity for rural and underserved populations?
MY : “One of the great efforts is to partner with other local hospitals and critical access hospitals, clinics, [and] post-acute care facilities to provide primary care and specialist care, surgical care, intensive care, [and] trauma services to our community and beyond. Efforts are underway to expand the interoperability of our medical records. This obviously facilitates the safe and secure sharing of health information for the coordination of care between sites and especially in our rural communities.
For example, we currently host our electronic medical record [called] “Epic” for Craig Memorial Hospital. We are looking at other ways to ensure medical record interoperability as a good starting point for good communication. Second, it’s an Intermountain initiative as much as a St. Mary’s initiative, and it’s the dignity of the patient…
There is ongoing training of caregivers on patient dignity, and we explore our own implicit bias and the hope is that we can ensure inclusion for healthcare for all people who are in our service area , focusing on inclusion and ensuring patient dignity.
Finally, our community health needs assessment process is the means by which we research specific programs and services and how they might meet the needs of our immediate community, not just in our community, but in our secondary service areas. and tertiary services that cater to these rural communities.
This is what we use to inform our recruiting efforts. This helps us tailor services to ensure we have access to all necessary services. This has been difficult during the pandemic as resources have been scarce. But we continually measure and monitor our wait times and re-examine ways to streamline our processes and improve patient access and health outcomes.
OR: How is St. Mary’s working with responders to prepare for the end of the public health emergency?
MY : “The biggest problem here is that if you continually focus on patient outcomes, quality of care and safety, you can never go wrong. And value-based care is the new entity that seeks to not only provide quality, safe, quality care, but to do so affordably. We’re trying to take this community-based approach to reducing the social determinants of health. And that requires a lot of focused coordination between all the different hospitals in the system, but also with some of the community organizations and the people around us here so that we can create a healthier population.
We try to streamline some internal processes, we try to reduce unnecessary waste and duplication in the system. As you can imagine, when you’re trying to integrate two disparate health care systems, even though we’re very closely aligned on mission and values, we have duplications and so we’re working to eliminate them, which helps to streamline and deliver care more cost-effectively. It’s work that we’re going to continue to kind of push forward in this post-pandemic onboarding phase that we’re navigating through. »
This interview has been edited for clarity and length.