Advancing Patient Flow and Clinical Excellence at Atlantic Health System with Dr. Geralda Xavier

0:00The most important health care decisions don't happen in isolation. They happen when leaders come together. Becker's 16th annual meeting brings together more than 3,500 hospital and health system executives this April in Chicago. With 800 speakers from Ascension, Cleveland Clinic, Common Spirit, and more, the conversations get real. Leaders will share how their scenario planning for policy shifts, breaking through value-based care barriers, and building clinical teams that translate new ideas into real-world care. Join top decision makers in the room April 13th through the 16th. For the agenda and event details, visit Becker's Hospital Review.com and click on the Events tab in the upper right. Hello, everyone, and welcome back to the Becker's health care podcast. I'm Mackenzie Bean, Associate Vice President and Managing Editor of Becker's Hospital Review. Today I am so thrilled to welcome back, Dr. Gerarda Xavier, who is a regional chief medical

1:00officer with Atlantic Health System. Dr. Xavier, welcome back to the podcast. Thanks for joining us today. Hey, thanks, Mackenzie. Really appreciate you having me on. I hope all is well with you as well, looking forward to our conversation. Yeah, I know we got to speak on the podcast last spring. So here we are, your leader, so I'm excited to check in and hear about some of the progress that you've made and the efforts going on at Atlantic Health System right now. But I'm doing well. Thank you for asking. Before we dive into the conversation, I'd love to turn the floor over to you, just briefly introduce yourself and tell us a little bit more about your work at Atlantic Health System for anyone who may not have caught your previous episode. Sure, absolutely, absolutely. So as you said, I'm a board-certifying emergency medicine physician and healthcare executive currently serving as a regional chief medical officer for Atlantic Health Hackets Town and new in medical centers. We are based in New Jersey.

2:02I've spent my career leading large complex hospital system through clinical, operational and strategic transformation, but always with a focus on quality, patient safety and health equity. So a little bit about me, my background combines both frontline clinical experience and executive leadership. I began my career in emergency medicine and progressively took on additional leadership roles from medical director and chair to chief quality officer to now my role as the chief medical officer. Those experiences has certainly helped shape my commitment to serve in diverse and volume populations while driving measurable system level improvements. Atlantic Health, I oversee clinical strategy and operations for new in-hackets town, medical centers to offer a community medical centers within our network. My responsibility while varied includes quality and patient safety, regulatory readiness,

3:06clinical outcomes, physician engagement and care coordination. I really work, it's a matrix organization and we work closely with our site base and system leadership as well as both employed and voluntary physician to align with strategy and performance. Really with the key to ensure that we're deliver and high quality, high reliable, strong value based care outcomes with exceptional patient experience. Yeah, over my career, you've led significant challenges and work with transforming organization to improve the quality and reputation programs. As we mentioned in the last podcast, one of the work we did is really focus in on how we improve readmissions for these vulnerable cohorts, pulmonary, congestive heart failure, COPD and acute myocardial infection. And that program has sustained some, while undergoing some challenges has really sustained good improvements over time, really which is

4:09something we're proud of. Also really looking forward to ensuring that we are continue to be leading frog A at our centers, reducing hospital acquired conditions. And really for me, really guide any emergency management responses while what we did during the pandemic and actually really post-pandemic, really trying to strengthen interdisciplinary collaboration, improve organizational key performance indicators. It really advanced for me personally working with physician to advance peer review transparency and enhance in both workforce engagement and satisfaction. So really, I believe sustainable excellence in healthcare comes from really aligning with physicians and frontline teams with executive leadership around a shared vision, delivering safe, equitable and high quality care for every patient every time. So really looking forward to this continued work

5:09that we're doing within our healthcare space. Yeah, I'm looking forward to hearing more about it. I think you paint such a clear strategic vision of this work and what needs to be done to really move the needle for patients in your communities. As you mentioned, the last thing around the podcast laid out some information for us in terms of the significant gains you've made in read missions, particularly for those vulnerable groups. I'm curious now speaking to you in early 2026, as you reflect back on the past 12 months, what would you say is the most important initiative that you have led? What did you do and what were some of the results that you've seen? Yeah, thanks. As we said, so many different priorities, so many things are important to the organization for many of the things you talk about. But one of the important initiatives I'll share that I've led and worked with the multidisciplinary team over the past years, really focusing on capacity management and patient flow, specifically looking to reduce lunch or stay while improving

6:14through good safety and overall experience. We are no different from many health care systems. We face rising volumes, workforce constraints, and increase in access challenges. And patient flow is a passion project as well for me because it's not just an operational issue. It is fundamentally a patient safety and quality imperative. As we know that delays in patient flow, delays in movement creates risk and is a dissatisfier for patients. They do affect care transition, it affects staff workload, and ultimately the care experience. So with that in mind, I organized and led a multidisciplinary capacity management and patient flow committee. We brought together stakeholders from across the continuum, such as nurse leadership positions, transport, bed management, and solar services. Really, the key was ensuring that everyone who touches the patient journey had both a voice and

7:18a shared accountability. Because I believe that flow is not owned by one department or one entity, it really is a system responsibility. With that premise, we really approach this work using a multi-modal strategy. We optimize observational level of care management by enhancing collaboration between physicians, physician advisors, case management to ensure we have the appropriate status designation early in the hospitalization. We partnered with our clinical leaders to safely shift appropriate diagnostic testing from inpatient to outpatient setting. This required really meaningful physician engagement in patient education, but it significantly reduced avoidable inpatient days without compromising quality. As a result, we were able to reduce our observation length or stay from an average of 36 to 48 hours to less than 30 hours and having able to sustain those gains. That improvement alone created earlier bit availability for patients requiring

8:23inpatient level of care and significantly improved our overall throughput efficiency. One of the other key measures we took on in this approach in this multi-modal strategy is redesigning daily interdisciplinary bedside rounds to improve real-time communication and identify discharge barriers early. This helps us to align with the care team around a clear daily plan and reduce communication breakdown. And I think more importantly, it helps us to identify discharge barriers early, whether that be clinical or logistical, such as transportation needs, so we can address them more proactively and reactively. That focused on daily goals and expected discharge dates directly reduces the interstate and improves throughput. It also supports discharge before noon and some other key performance indicators and ensure beds available when patient needs it for the inpatient level of care. Equally though, it does strengthen team engagement. Everyone

9:28understands their role, their shared accountability, and everyone's working from the same plan. And really when done right into disciplinary we call IDR rounds can shift culture from the fragmented care to really coordinated, high reliable care that benefits all, including patient and staff. And finally, you know, we talked about the way I really believe in robust process improvement in our last episode. And this is no different in this project where really we use lead methodology to help us streamline direct bedding from the emergency departments. You restarted by just mapping out the process to really understand where the delays in the handoffs and rework occur. And then we standardize that work, therefore reducing unnecessary variation and eliminating steps that don't add value. The use of lean help us to decrease the variation and workflow between providers, both the ED providers and hospitalists that that previously led to delays and redundant handoff. By standardizing the direct communication

10:34between those teams, that helps to eliminate the non-value added steps and remove barriers to timely bed assignment. And this also helps us improve transparency around throughput metrics and significantly reduce admission to bedtime. So this process really helped the team to empower their frontline teams to solve problems and shift the culture, again, from just a reactive, firefighting to discipline, continuous improvement. Overall, we achieved the measurable reduction in electricity from our baseline. We improved admission to bedtime. We shortened observation stays as I mentioned to 30 hours and under. And we improved some other KPIs such as discharge before noon. And that translated to really improve access and decreasing ED boarding, improving our financial performance and higher patient and staff satisfaction. But I must say, for my perspective, it really is not just about the metrics. It really is about

11:37shifting the culture, moving from reactive crisis management to proactive capacity planning. We really built a high function in multidisciplinary structure that continues to drive improvement and resiliency across the organization. So that culture shared from creating a shared ownership of flow across the different multidisciplinary teams that I mentioned is what we know will sustain the results long-term. So this is really exciting work that continues a day-to-day, but it's really nice to see how that structured approach has allowed the teams to be empowered to continue to ensure that their processes are followed. And whenever there's opportunities where we may shift or there might be some what I call metrics that may not be forming well is to really look at it through the lens of structural problem solving to say, what's not working? How do we get back on board? What do we need to do to engage? What is it that we're learning from the teams and do we need to pivot

12:39or any of those? So pretty exciting work that we continue to do. Yeah. Very exciting work with some significant results, as you said. And I so appreciate your note about the descriptive structure being important, but also the culture really underpinning everything, as you said, patient journey, needing to be everyone's accountability. I think that's such a key part of it. I'm curious now looking ahead and say over the next 10 months of 2026, what would you say are your biggest priorities and headwinds that you're focused on now? Yeah, great question. It feels like we just came out from these respiratory surges that we see across the country, but really looking ahead, our focus is centered on events in our organizational strategic priorities while navigating some of these real headwinds and health care. A couple of

13:43priorities, one is definitely your clinical excellence. It remains our foundational priority. We are continuing to strengthen our high reliability practice, reduced preventable harm, and really leverage data to drive consistent evidence-based care across all service lines. I will be remiss to say one of the most important factors as well is really improving our consumer experience. Patient-expect access, transparency, and seamless coordination. So we're really working to simplify the care journey while expanding digital capabilities and improving communication. You know, leveraging workforce experience and elevating workforce experiences also a top priority. I mean, I'm showing talking to other leaders across the country as you do through this podcast and other avenues of communicating with healthcare leaders. I'm sure you hear about workforce fatigue, recruitment pressures, and retention challenges. And they remain

14:46headwinds across the industry. We are focused on engagement, leadership development, and create an environment where our team members feel supported and heard and empowered to do their best work. And again, financial stewardship underpins everything with ongoing reimbursement pressures and rising costs. You know, we have to stay disciplined. We have to use data to drive decisions and operationally stay efficient while continuing to invest strategically in quality and innovation. So like I said, the headwinds are definitely our workforce constraint, regulatory complexity and margin compression, which are real. I believe organizations that state-incurring quality, equity, and strong physician alignment really is best positioned to withstand 2026 and to thrive beyond that. Mm-hmm. That focus is really core to everything, right? Yeah. As you said, there are a variety of

15:50headwinds that not just you, but health system executives across the country are facing right now, obviously, acknowledging those, what do you think specifically is going to be the hardest thing that you have to do over the coming year? That's a great question, Mackenzie. I think the hardest thing in the coming year will be balancing those financial discipline with our commitment to clinical excellence and workforce engagement. As I said, we can tell here continue to face margin pressures, reimbursement and certainty and rising labor and supply costs. But at the same time, we're responsible for patients and our teams are having change. In fact, the expectations are even higher than ever. And so the challenge is making thoughtful data-driven decision about resource allocation without compromising safety and quality or access, especially if you're in community hospitals. Access can definitely be sometimes a challenge. Another difficult aspect in the coming

16:53year is leading through continued workforce fatigue. I know that several of my colleagues with any emergency medicine feel as well as in leadership have pivoted away from some of that to other less grueling opportunities due to just fatigue. Even as we move toward from the acute phase of the pandemic, I think we still see the emotional and operational toll that remains. So supporting our teams while also making sure that they can adapt to change, improve efficiency and embrace innovation will require a different type of leadership that includes empathy, transparency and steadfast leadership. So I think the ultimately, you know, the hardest part is making sure that we make these tough decisions, but in a way that maintains trust and trust with our frontline team, with our physicians, teams, with our nursing team and our community. That means

17:55that we really have to have really great communication, shared accountability and really staying anchored in our mission. And I think if we can do these things while very difficult, that will create opportunities to strengthen the organization. Absolutely. Dr. Xavier, I'm always just so impressed that, you know, you're focused approach your dedication to quality and clinical excellence. And it really shines through in your remarks today. So thank you so much for rejoining us on the podcast to give us a glance at to some of your priorities and focuses right now. We so appreciate it. Is there anything else you'd like to add or end up? No, I think again, thank you so much for the opportunity for the conversation. I really appreciate and enjoy, you know, these chats. I think that as leaders, we are all trying to really be supportive and make sure that we are able to provide what's

18:57needed for team members in a really in an environment that is psychologically saved, that empires them to be their best, that empires them to work at the top of their license. And, you know, and making the environment a great place to work. And I think we land to kill system as an organization of always prioritize being a place that our team members can find a great place to work because we do provide some of these not just the ability to feel safe and to have joined in work, but also focusing really on succession building, workforce development, engagement, leadership support, and really providing the infrastructure so that they can do their best work and work at the top of their license. So, you know, at this juncture where we are, it really is really enlightening to continue to journey with an organization that has such a great priority on its workforce. So, thank you so much once again. I hope to see you one of these good days as

20:05yes, we're excited to have you at our annual meeting in April. Looking forward to it. Wonderful. Well, thank you again so much Dr. Xavier and listeners. Thank you as well for tuning in. You can find more podcast episodes by visiting the Becker's podcast page at Becker's hospitalreview.com slash podcasts.