Joey Wahler (Host): It's a role previously held by one physician, now shared by three people at Community Memorial Healthcare So, we're discussing the unique structure of the Office of the Chief Medical Officer, or CMO. Our guests are Drs. Kellie Zaylor, Lamar Bushnell, and Debbie Carlson, all Chief Medical Officers for Community Memorial Healthcare.

 This is Wise and Well, presented by Community Memorial Healthcare. Thanks for listening. I'm Joey Wahler. Hi there, doctors. Thanks to all of you for joining us.

Lamar Bushnell, MD: Hello.

Deborah Carlson, MD: Good morning.

Kellie Zaylor, DO: Thank you.

Host: So first, we'd like you to each tell us your medical specialty and area of expertise and how long you've been with Community Memorial Healthcare, starting with you, Dr. Zaylor.

Kellie Zaylor, DO: Sure. So, I am Dr. Kellie Zaylor. I am board-certified in family medicine, currently practicing in the urgent care setting, and I've been with CMH for 10 years.

Host: And how about you, Dr. Bushnell?

Lamar Bushnell, MD: I am a cardiothoracic surgeon. And I have been with Community Memorial Healthcare for-- this is my 29th year.

Host: And you, Dr. Carlson?

Deborah Carlson, MD: I specialize in internal medicine, specifically hospital medicine, and I'm also the past Program Director of Internal Medicine. And I think I started just before Dr. Bushnell, and I'm approaching 30 years.

Host: Wow. Well, congratulations on that. So back to you, Dr. Zaylor. What's the primary role of the Office of the Chief Medical Officer for those unfamiliar?

Kellie Zaylor, DO: The primary role of the Chief Medical Officer really is to lead on clinical improvements and quality measures. We also do a bit of physician and staff education, work with developing clinical protocols, and are the voice of leadership between administration and the medical staff.

Host: For you, Dr. Bushnell, what's important for your patients and the community to understand about what a CMO does on a daily basis, do you think?

Lamar Bushnell, MD: Well, a hospital runs obviously with doctors, nurses, and the people at the bedside, but it's managed and the doors are kept open by our administration. The Chief Medical Officer is really a liaison between the caregivers and administration. We bring back what's working, what's not. We do help with education. And we're involved in many of the administrative decisions, providing the medical and the bedside perspective to the administrators who are more focused on financial and aspects and operations.

Host: So for you, Dr. Carlson, what do you think the value is in this new collaborative structure? And how will this approach, do you think, enhance the care that Community Memorial Healthcare provides for its patients?

Deborah Carlson, MD: Community Memorial is really diverse, you know, with over 20 clinics and five residency programs and two hospitals and a skilled nursing facility. And there's not one person that can really drive quality in all those areas. So, I think the three of us with our unique areas of expertise are able to cover pretty much the whole system and identify problems and help provide solutions.

Host: Gotcha. And so for each of you next here, how would you say you're applying your particular area of expertise? And what would be your main focus or goal? Let's start with you, please, Dr. Zaylor.

Kellie Zaylor, DO: Yeah. So, my main area of expertise are the ambulatory clinics, of which there are 22, representing about 30 specialties. So, the value is that when we come together, we can combine our areas of expertise. So, mine would be the ambulatory clinics. The goal for me for ambulatory medicine is really improving our patients' experience in the clinics, helping to implement programs that increase preventative screenings and overall patient wellness.

Host: How about you, Dr. Bushnell?

Lamar Bushnell, MD: Kind of at the other end of things, we tend to take care of the people that aren't well. I'm in the operating room, in the ICU and telemetry unit everyday. And I think my main role in my part of this trinity of CMOs is to bring the perspective of the OR and the ICU, help to support. We do almost 40 operations a day in the main ORs and the same-day ORs. Our ICU is a busy ICU. At one point during the COVID pandemic, we had over a hundred patients.

So bringing back to administration, what the needs are, what they can do to help support patient care, they've been very responsive. We have some support mechanisms like a temporary artificial heart and lung system called ECMO that no other community hospital has an active program there. They really have supported us and so we've been able to provide technologies in a community setting you usually see in a big tertiary or university center.

Host: And you, Dr. Carlson?

Deborah Carlson, MD: I think I have two areas of focus. One, I'm considered the lead CMO, so that job really is to make sure that the three of us don't stumble over each other and duplicate our efforts. And then, the other is really my highest priority right now is developing what we call a dyads. They're a pair of a medical director and a clinical manager, and they collaborate on quality improvement projects. So, we have 33 dyads currently working. So, for example, our inpatient dyad, Dr. Christina Desai and her partner, Diane Cornell, who's the nursing manager part of that dyad. They're working on improving medication education at discharge. So, I follow all of those dyads and help them with any resources they may need. And then, I focus mainly also on inpatients, so Dr. Bushnell and I overlap a little bit, and as well as the Continuing Care Center and Graduate Medical Education.

Host: Switching gears a little bit, back to you, Dr. Zaylor. Community Memorial Healthcare recently implemented a new strategic plan, as it's called. So, the public can relate here. Why would you say having a well-crafted strategic plan is important to patients in the community?

Kellie Zaylor, DO: The strategic plan really serves to give a focus to not only our team as CMOs, but others in the hospital. It really gives the organization direction as a whole. It holds what our strategies are, what our goals are, out in front for everyone to see. It's easily followed. Everyone knows what the goals of the organization are. We focus on things like infection prevention, screenings, wellness, patient satisfaction. And this is really important to our patients because it is evidence that our hospital is dedicating to improving the health of our community.

Host: Dr. Bushnell, how does the Office of the CMO, would you say, support that strategic plan?

Lamar Bushnell, MD: Well, in the ways that we have just talked about, the strategic plan really sets goals, goals that are critical for us to keep this community hospital going. It's increasingly difficult. You know, 600 rural and community hospitals are closing or in the process of closing across the country. We're one of the last free-standing healthcare systems on the entire West Coast. This hospital system is owned by the people right here, so there's no deep pockets. We're not part of CommonSpirit Health with 130 plus hospitals or HCA. So, we have to focus on not only providing really high level care for our neighbors and the people in this community, which is our mission, but also keeping this hospital viable so they can keep new equipment, keep state-of-the-art new doctors. So, I think that that is really our goal, is to help the hospital in that regard to continue to grow and to continue to be viable in a really increasingly difficult market.

Host: Gotcha. Dr. Carlson, since we have here a three-headed CMO, so to speak, what would you say is the key to the three of you working so well together?

Deborah Carlson, MD: I think we like each other. I think that makes a big difference. Again, we all have our area of expertise, and we respect each other in terms of looking towards each other whenever there's an issue in those areas. So, it works quite well we meet every week to talk about what's going on. We stay informed so we can collaborate in the best way for the system.

Lamar Bushnell, MD: Yeah. We all come from different perspectives, and I think that's very helpful. And in the past, the 23 clinics were out there sending patients our way, but I don't think we were very familiar with how they worked and all the doctors there. And so, Kellie brings that. As far as the residency program medicine, Deb was a residency program director. She brings that aspect, and I bring the aspect of the ICU and the ORs and the cath labs and the procedural areas. So, we all have a different perspective. We all think a little differently. You know, everybody is thinking the same and someone's not thinking. And so, we all have different perspectives and are not shy about sharing those with each other and with administration. I think we're all in positions where we can say exactly what we think and are not shy and don't hold back when we're dealing with administration. We also have a very, very supportive and collaborative administration. The doctors here actually like the administration and vice versa, which is somewhat unusual in many hospitals.

Deborah Carlson, MD: It's probably important to note that we're all still working in our areas, too. It's not like we were working in those areas and now we're just administration. We are still all working in our respective areas.

Host: Good clarification to make. And how about you, Dr. Zaylor? Since there are three of you, when there's a big decision to be made by the trio, and perhaps there are dissenting opinions or votes, who casts the final one? I'm talking big decisions like, say, where the three of you are going to go for lunch for instance.

Kellie Zaylor, DO: That is the most important thing that we deal with on a day-to-day basis, which is where we're going to go to lunch. But besides that, the big decisions, one doesn't outweigh the other. So yes, Dr. Carlson is lead CMO, but we are collaborators in the truest sense of the word. And so, we will work together and have multiple conversations and it's great to have dissenting opinions. That way, we can work through things. And like Dr. Bushnell said, we're all passionate about what we do. And so, we basically sit down at the table and work through things until we come to a decision that's best for the organization.

Deborah Carlson, MD: Or if we don't have a decision, if we can't make a decision, we present our differing views to administration. And that's what they value as well, just hearing our different perspectives on a problem and then they can make the decision.

Host: Understood. And so finally, in summary here, let me get a take from all three of you on this. What developments are each of you most excited about for the future of Community Memorial Healthcare that people can expect? Let's start with you, Dr. Zaylor.

Kellie Zaylor, DO: I think that I am most excited about how this new structure will bring us all together and benefit the organization as a whole. We are more informed in our leadership and we'll be able to do more for our patients. Our patients will be able to be confident that we're making the right decisions, the right policies in the right areas, improving our patient's experience and our movement through the system from the ambulatory clinic to the inpatient to discharge, we really want that to flow smoothly, expanding our outpatient services and inpatient services as well to better provide for the health of our community.

Host: Dr. Bushnell?

Lamar Bushnell, MD: I think the collaborative approach that we're taking with administration, including this office of CMO kind of exemplifies how CMH works. We have a very unique culture and that it's collaborative. We're non-union and we're not-for-profit. Everybody seems to pull in the same direction here, which you don't see at a lot of places. And that's important. It's going to be a very challenging time. So, what I see is just maintaining our status as a kind of preeminent community program in a time that's going to be difficult.

We have some things coming on. We're getting a new electronic medical record system that is state-of-the-art, it's called EPIC. That's what the big university centers use. We'll be getting that in the next year and a half. And then also, there's a real effort to connect more with the community and let them know the other things we do. We have a fantastic health fitness center that's available right next to the hospital, outpatient laboratories, outpatient x-ray, and we're really working on making that more available to our community.

Host: Dr. Carlson?

Deborah Carlson, MD: Well, I don't want to repeat what everybody else said because I'm excited about those two things. You know, I'm always excited coming from the GME world to see all of our graduates moving into the area. We have a great need for primary care physicians and We've been able to provide many to the community as well as surgeons to the community. So, it's been a great program to get new physicians, new young physicians, really smart people into our community, taking care of our patients. The electronic health record, I think, is going to be wonderful. It'll keep us connected with other area hospitals as well as the tertiary centers, which will help our patients. And just these quality projects that we're all overseeing, I think, is going to improve the care of our patients. So, I'm excited about that as well.

Host: Well, folks, we trust you're now more familiar with the Community Memorial Healthcare Office of the CMO. Doctors, congrats on this new arrangement, and continued success. And thanks so much again.

Lamar Bushnell, MD: Thank you.

Deborah Carlson, MD: Thank you.

Kellie Zaylor, DO: Thank you.

Host: And for more information, please visit mychm.org. Again, that's M-Y-C-M-H.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for listening to Wise and Well presented by community Memorial Healthcare.