Care Redesign and Patient Experience (ft. Dr Judy Wolfe)

Thanks for tuning to Digital Voices Podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now, your host, Ed Marx.

Hey everyone, Ed here with Digital Voices. Special treat because it's a colleague of mine and we've worked at the same organizations and most recently at the Cleveland Clinic. And now, Dr. Judy Wolf, you are CMO at University Hospitals for St. John's. So welcome to Digital Voices.

Thank you so much, Ed. It is such an honor to be here and to join you today.

Yeah, we're gonna have a lot of fun because again, we have all these natural connects and you're sort of an innovator, leader, digital person. And so it's kind of fun. But before we get into that, Judy, everyone wants to know what songs are on your playlist?

Oh man, Ed, I'm so bad at curating a playlist. So once a song goes on, it like never comes off. And so I then get annoyed. So recently I've been listening to curated playlists, so like playlists that other people put together, like on Spotify. I went for a trail run over the weekend and I listened to throwback jams, which is such a guilty pleasure. So Pitbull and Taylor Swift. Oh yeah.

Yeah, that's good stuff, especially out trail running. So trail running, tell, tell us about trail running. Like how long have you been doing that and what's the, some of the distances that you've done?

So I started on my journey that eventually ended me in being a marathoner in 2014, probably around like 2010. So I started running 5Ks and trying to lose some baby weight after my youngest was born. Um, and then after running the Chicago Marathon, I realized that my knees were 40 and They couldn't take that anymore. Um, so I started sort of doing some hiking and then going on like trail runs. And so down here in Cleveland where I live, we have amazing metro parks, the Braxville. And now I live in Shaker Heights. Um, Shaker has Shaker Lakes.

Wow.

And it's just absolutely gorgeous out there in nature and to go around the lake on these like kind of light trails, but get a little scoot in there, right? Um, yeah. Because I'm now almost 50. And my knees still can't take it, but it can take it a lot easier when I'm on some soft trail.

That, that's cool. Yeah. And I don't think most people realize Cleveland has perhaps, you know, the best for a large metro area, a Metropark system, and they're all connected and you could run forever, like forms a big ring. And, and then of course you got the Great Lakes. And, and what shocked me when I first moved there was the hills. I mean, there's like serious hills. I mean, it's beautiful. It's, it's pretty amazing place. So I'm kind of jealous cuz I bet you are able to walk right outta your neighborhood and get on around those lakes and on those trails and stuff. So that's pretty cool.

Yeah. I think getting out in nature is so crucial for your mental health. And I love it. It's absolutely gorgeous here. It's not the hilliest place that I've ever lived, but it's not completely flat like you would expect the Midwest to be.

Right. Yeah, that was what was surprising to me. What about a life message or mantra? Are there words that you live by?

Say yes. Sometimes it's a yes and sometimes it's a yes and, but every time I've questioned myself and I've pushed beyond my comfort zone, I've always been really gratified in embracing that challenge. And sometimes you fail. Right. You can't be afraid to take it out. Sometimes you just have to say yes. And so every time I've jumped, I've been happy I jumped. Sometimes it wasn't very easy right away.

Right.

But I've always been happy.

I love that, especially when, when, when I talk to CIOs or people in the technical ranks that a lot of times they were just raised on saying no. And I was like, that's not a way to collaborate. And you need to learn how to say yes and. And so we'll talk about that a little bit later 'cause I wanna get your perspective as a CMO on working with sort of tech leaders and how you do that. So yeah, that's a great mantra for all of us for sure. Tell us a little bit about your story. We already know a little bit about where you are and what you like to do, but take us back to your early days. Where did you grow up and take us all the way to where you are now?

Sure, that's a long story 'cause I'm old now. I grew up in West Virginia. Work. Um, I went to Johns Hopkins as an undergraduate. I finished in 3 years by going to school year-round. Um, went to medical school at the age of 20, graduated 24, and was one of the youngest licensed physicians in the year, I think, 2001. Um, when I, when I finished up, um, did residency in Buffalo Moved to Rochester, New York for my first job, and then got a postcard in the mail inviting me to come to Cleveland, Ohio. And again, that was one of those, should we say yes? And the answer was yes.

Yeah.

Not even a yes, man. I put all my stuff, my cat, my 2 dogs in, in a rented truck and moved to Cleveland, Ohio in 2006. And I've been here ever since. And went through, I'd say, a lot of jobs. As an emergency physician working for contract management groups, you have a lot of flexibility, and I took advantage of that flexibility to create a schedule that worked for me and my family, as I had a young family. And then in 2015, interestingly, our contract management group was bought out. The contract was purchased by Cleveland Clinic, and we were Invited to reinterview for our jobs.

Yeah.

And some people made it. There were like 100 new physicians that were hired back in. Um, some didn't. And I had the opportunity, um, from John Tafuri, who was, uh, the regional chair at the time. He's like, hey, I need a medical director for the Lakewood Hospital emergency department. As you know, they're gonna close that hospital, but the ED's gonna stay open and we're gonna move across street into a brand new building. It's going to be crazy. Do you want it? And I was like, yes, let's do that. And had the opportunity to become an ED chair, was the last, the last survivor, the last standing physician and leader in that hospital when it closed. Was able to have the opportunity to build the amazing family health center that we built across the street and learned a lot along the way.

Yeah.

It was kind of a scary time because the community was very angry at the closure of the hospital. And so I had to take additional training in learning how to deal with the public, how to handle the conflict, how to be a public spokesperson for the Cleveland Clinic. And I got incredible training. Um, they really invested in me. And, you know, spent a lot of time teaching me how to communicate. And I was able to kind of parlay that effort in addition to the operational changes that we made to make that emergency department one of the highest functioning in the system. I was able to parlay that into my next job and became the Associate Chief Experience Officer at the clinic on January 1st, 2020. And we all knew what happened in 2020.

Oh yeah.

Things changed really quickly. And again, took advantage of every learning opportunity. Kind of going along that road. And just over the last 9 months, subsequently transitioned into an operational role here at University Hospitals, which has been fabulous. And I'm, you know, again, another big scary life change after working at the Cleveland Clinic for a long time, both as a contract physician and then as an employed physician. Stepping out of your comfort zone is terrifying.

Yeah.

And yet, So incredibly worth it. So I've been in my current role now since July 1st and continue to learn and grow here.

Yeah, that's awesome. And I like your spirit because I'm sort of wired the same way, sort of adventurous and moved different places, took different roles just because it, it's so exciting and you learn so much. So that's pretty cool. When did you know you wanted to become a physician? Like, was it in your, in your youth or, or later in early college?

Oh, and I was like 12 years old.

Wow.

Yeah, it was crazy. You know how like how you have teenagers and your teenagers get like a group of friends and like they always make you nervous? It's like, I don't know about Emily. Well, you know, interestingly, my group of friends, there were like 8 or 10 of us that were kind of in this little clique of brilliant little girls who were over-functioning from a really young age. And we all became doctors.

Wow.

When I look around, like, we could— we like took over the world. I've got a dear friend who's the division chief of pediatric pain management at Texas Children's, another one who leads electrophysiology, you know, did her training at Johns Hopkins, leads that at, you know, St. Louis VA. I mean, it's just absolutely beautiful, sweet little girls who just pushed each other to the limit academically. And we all became doctors. And so that's kind of what I'm hoping for my own daughters is that they kind of fall in with the groups that push them to be their best. Not to say that we weren't occasionally busted by the police for drinking in public. We won't talk about that experience, but, you know, overall, you know, I think a lot of who you become is who you're around. And my group of little friends kind of pushed me into, you know, a trajectory of success. And for emergency medicine in particular, you know, I was that, I was that kid at the end of third year. So just for context for your listeners, your third year of medical school is really a transformational It's the first year that you spend all your time just to like kind of understanding what real clinical medicine is. You do 8 to 12 week rotations on every different surgeon service. So surgery and medicine, pediatrics, obstetrics, psychiatry, like you do a little bit of everything. And I got to the end of my third year and again, it was one of these like absolute crisis because at the end of your third year, Now you're a 4th year and you've gotta know what you wanna be for the rest of your life.

Yeah.

I had absolutely no idea. I liked everything. Like when I was on pediatrics, I wanted to be a pediatrician. When I was on psychiatry, I was convinced I was gonna be a psychiatrist. Like it was gonna be all these things, but then they were forcing me to choose. I, you know, I'm this like 23-year-old kid who like, I lived with my mom and dad. Like my mom still did my laundry. Like, You know what I mean? Like, I didn't know anything about the world. I was a child. And I met a mentor of mine, Dr. Spurgeon. And Dr. Spurgeon was an attending with a capital A. This gravitas radiated off this guy. At that time, he must have been in his 50s. He was always dressed to the nines, you know, button-down shirt, like always looked way too fancy for the emergency department. And I, you know, he asked me, you know, what are you gonna do, um, with your life? And I think I started to cry. I'm like, I, Dr. Spurgeon, I have no idea. I had no idea.

Yeah.

And he's like, I told, I like everything. How do I pick? And he said, Judy, you're an emergency physician. We all like everything, but we all don't wanna do any of that. And I was like, how do I know? He's like, come with me to the department. Come on night shift when I'm working. And just see it for yourself. And so I went, and the first person that I saw was an absolutely drunk-off-her-pants lady who had put her arm through a glass window. And he said, fix her up. And this laceration, I gotta tell you, it was like 10 inches long. She needed to go to the OR. He did a damage control repair. They're like, here, like, whatever you do with it, it's totally fine because somebody's harder than he's gonna fix it in a couple hours. And so I went and picked out a bunch of glass, probably like a 3-hour project, and I stitched her up and chatted the whole time. And when I walked out of that room, I knew exactly what I needed to do. I knew that was my home. And I did a bunch of rotations my fourth year in emergency medicine, and I decided to do this for me. And it's crazy because At the time, this is like 1999, um, at the time only 17% of emergency physicians were women. And so I went on, on interviews where I didn't see another female face.

Yeah.

And so it was a scary jump. Again, you have to remember, like, I'm 23, 24 years old. I'm literally a kid making this huge decision for myself and so far out of my comfort But here I am, I'm 25 years later and I love it.

And yeah, sometime we'll have you back, talk a little bit about women in leadership. You were sort of a pioneer as a physician leader and like you said, through the emergency medicine in particular. And that'll be super interesting to hear about your journey and provide some guidance and vision for others. So that's pretty cool. So you did some time as Inpatient experience, and then you came over to University Hospital as the chief medical officer over there at St. John's. And what drew you to UH? Tell us a little bit about UH before we go into your job specifically.

UH is a large integrated system serving just about a million patients a year. We're in 21 hospitals, 50 health centers, 200 physician offices. It's across 16 counties in Northeast Ohio. My particular hospital is the only Catholic hospital. It's the only religious hospital in the system. So it's got kind of a unique feel to it. And we have a Medicare-dependent hospital. We've got about 120 beds, do a ton of internal medicine. We've got multiple surgical service lines. We're a center of excellence for advanced endoscopy and neurosurgery. Spine surgery here in addition to multiple other specialties. And we've got the best emergency department in the system.

No bias, no bias there?

No bias. Not even a little bit of bias. Fabulous. Yeah, we, and it's, it's a really, it's a great system. I think in general, I think there's a huge focus on valuing physician leadership in particular. And that was part of the draw for me. Is that when you look across the chief medical officer team, the vast majority of the chief medical officers running the hospitals are emergency physicians. And when you look also at the gender makeup, it's half female, half male. So it's a, it's a very balanced system and they value people with decision-making capacity and ADHD. So it was totally, I found my people here. Yeah, it's incredible.

It is a great, great organization, and Cleveland's really blessed by having, you know, between Metro and the public health, you know, they're— it's, it's really strong. That's another nice strong thing about Cleveland is the medical community is, uh, super tight and super strong, and you wouldn't want to be in any other city, I think, you know, if you had something going on with you.

Yeah, yeah. I, I've got, um, parents-in-laws that live in Florida, and I make them come here for all of their sick Healthcare, which they love and hate it.

Right. Yeah. It can be hard coming from Florida in terms of the weather, depending on the time of year. So now you've got this great experience as a practicing clinician, a lot of variety, variation. You serve at the Cleveland Clinic and leadership and then patient experience for a few years and particularly through the pandemic. And then you come over chief medical officer. What are one or two of the key objectives that you have as chief medical officer?

So, for me, it's a balance of fighting the fires and illuminating the mission, right? So, it's equal part operations and vision, kind of illuminating the way, helping people align to the goals. We're really busy with lots of different projects. You know, some of the big things kind of working on right now where I'm moving a lot of people's feet, and this is the big challenge we're kind of facing. Is looking at our throughput. And so when I look at where the opportunities are for throughput, for optimization in my hospital, we have a lot of variability in observation. So when I look among my physicians, I've got physicians that can get patients out in the prescribed 24 hours. And then on the other end of that, I have people whose average is closer to 60. Those same patients, they concerns, massive variability. So stamping out that variability by making it easy, making sure the resources are in place, making sure we have a prescribed approach and are following best practice guidelines. That's really where a lot of my focus is right now, is trying to ease the way for patients. Kind of talking a little bit about what got me from patient experience to operations. For me, it was realizing that all the patient experience is operational, or at least 95% of it. Yes. Yeah. And now we had really over-indexed a little bit, I think, historically on communication. Communication is really important. You have to be able to express yourself and demonstrate empathy. That's kind of table stakes in the patient experience. But what we really didn't focus as much on was on how easy it is for people to get the care they needed. And, you know, working with Adrienne Boise at the clinic, she was probably one of the most brilliant visionaries I've ever worked with. And she really kind of beat that drum, right?

Yeah.

And wanted us to look at, and embedded in 2020, a question onto HCAHPS asking, you know, about the ease to get care at Cleveland Clinic. And we really didn't look at that data 'Cause we didn't have benchmarks for that data. So we kind of put it on the back burner for a long time, kind of fighting the issues of the pandemic, got a little bit distracted. And once we started looking at that in 2023, the way that we did that was really by assessing verbatims, by using large language models, by using ChatGPT actually to process verbatims. We're looking at these verbatims and kind of synthesizing The stories, the message from patients. And what came out for me was another crisis point in my career, realizing it was, it was about the quality of communication in terms of the information sharing, but it was also about waits and delays. And in my role as a patient experience leader, I didn't have any agency over waits and delays. I could kind of show that to the people I was trying to influence.

Yeah.

I couldn't fix that for them. And it was at the end of 2023 where I kind of hit the wall and decided, oh my gosh, I got to get a job in operations. If I ever want to have the influence, if I ever want to have the influence I want over patient experience, if I really want to make that great for people, I've got to be back in an operational seat. And that's That's how I kind of made my transition back into a job like this as a chief medical officer, because now I had the authority to influence that way.

Yeah, it makes— that makes total sense. And I can see that where you're sort of in a strategy role and you can come up with great strategies and principles and values, but at the end of the day, you're not able to actually make that strategy unfold when you're in a, you know, more of a strategy position. But now that you're in operations, you can take both. Like you said, that's kind of your, your 2-part objective or mission as CMO is to illuminate the mission. So there's kind of the strategy, but you're also involved rolling your sleeves up and making stuff happen. So it's kind of the best of both worlds. So I could, I could see how that'd be really gratifying. I know, Judy, that you're really Into care redesign. I've read a little bit about what you're all doing there. Can you give us an example for someone who might be listening? And when you hear the concept of care redesign, like, can you share like maybe one thing that you all have done that you're particularly proud of?

Oh gosh, yeah, triad rounds. I know that this is Digital Voices. This is the most analog process you could possibly imagine. So what triad rounds are, they bring the doctor, Or APP, the nurse and the patient together every single day to basically have a huddle or a debrief and talk about what's my diagnosis, what am I waiting for, what are the results of my tests, what are my next steps in my care, what's my discharge plan, you know, what can I expect? Like all the signposts along the journey of your hospitalization, but just on a day-to-day basis. And so the triad rounds are, they sound so simple, like this is how medicine should be practiced, but getting people together, like if you've ever tried to book like a Teams meeting with 2 other people and yourself, you know how hard that is? It's like, okay, well we're scheduling now out in November.

Right.

Like it gets complicated. And so resolving that complication that we can bring these 3 crucial players together every single day, have them be on the same page. That's the challenge. And we've been incredibly successful here, in particular at St. John. I have absolutely incredible junior leadership here in the form of my hospitalists, like great hospitalists, super engaged, absolutely love this work, and have been able to bring along their teams. Great nursing leadership. And nursing's super engaged with this. They see the value. Like, you don't ever have to convince a nurse to do a triad round because they love being part of the conversation and included, and they know what's going on. They're well-informed. They can hand that information off to the next shift, and everybody's together. It's an incredible process. And this really— this is how we should care for our communities. This is how we should care for our patients.

Well, I love what you said about the analog, 'cause yeah, I think often we jump to sort of a digital solution or a tech solution when a lot of times you just gotta break down the processes and look at it with analog eyes and then let the tech come behind it. Sometimes we try to sort of lead with the tech and I'm always advocating for the opposite. Like, let's figure out, you know, the simplest ways to make this work and then we can complement it with sort of some digital tools if you needed. So yeah, super interesting. Wow, I would love to talk more about that as well, but I wanna jump to a leadership question and sort of wrap up our time together. What is the one best piece of advice you received, like, as you make your transition as a leader? You know, 'cause leadership's hard and we don't necessarily get specific training for it. Is there something that someone shared with you or you read or heard that has helped you in your journey as a leader?

Oh, absolutely. So I have a great mentor. who is my previous boss at the Cleveland Clinic, Leslie Jarecko, really brilliant woman who was somebody that I do and I did want to be when I grew up. And Leslie is somebody who taught me a lot about stakeholder management. And she gave me some advice once that sometimes I run too fast. Now, nobody's ever told me that out on the trails, right? I'm a solid, like, 10-mile kind of gal on the trails. But in real life, I realize, like, I process quick as an emergency physician. I move quick. I decide quick. Like, these are all strategies that are super protective if you're an emergency physician. Nobody wants their ER doctor to, like, pontificate for 20 minutes.

Right.

While bleeding to death.

Yeah.

But sometimes in leadership, especially when we're talking about big changes, bringing your stakeholders along with you, alongside you, can be really hard, especially when you get that resistance, right? Like, people don't want to change, and it can be really easy to be frustrated with other people's intransigence or lack of attention to the problem that you're trying to solve. And, and so running too fast and not bringing them along is not solving the problem. Sometimes you just slow your pace, and sometimes you got to run circles around them. Yeah, to get them to kind of move a little quicker. But you have to bring your stakeholders along because none of us does this in a vacuum. This is a team effort. So keeping that team together, motivating the team, helping them see their place in that solution is crucial.

Yeah, that's, that's good. What about advice you might have For about 60, 70% of our audience of Digital Voices comes from a tech background. And so they're used to working or trying to work and collaborate with clinicians. What advice, like from a CMO perspective and plus all the clinical perspectives you've had before, when you think about working with like a CIO or some peer counterpart like that, what advice might you have for that individual?

Well, you've gotta solve a problem I care about. Everybody's talking about AI. We're a little nervous about AI. You have to remember, like, as a physician, like, sometimes I like to brain rot and I watch TikToks. I think TikTok knows I'm a doctor because it'll show me TikToks about all the physician jobs that are going to get eliminated by AI.

Right.

And part of me is saying, well, if the bot wants to take baggies of cocaine out of people's butts for a living, let them have at it. Like, that's your job now, AI. But, you know, the other half of me is also really skeptical and scared that I'm going to get replaced. And so AI, I think, is having a little bit of a backlash. Maybe don't put that out in front of me so much as a clinician. Instead, focus on the problem I care about. that you wanna solve. And you can tell me the details about how you're gonna solve it. You know, tell me about the large language models and tell me about the machine learning. But I think AI is kind of an overused term, and I think it makes us with the clinical background kind of afraid.

Yeah.

To a little bit, there's some skepticism, some cynicism, some fear there. So, you know, when you're branding it and you're selling it, Sell it to me as a solution.

That's really good advice. I like what you said. Yeah. Solve a problem that I care about. Wow. We talked about a lot of different things, Judy. It's been super fascinating learning more about you and your journey as a clinician and working with a couple world-class organizations. What I, a couple key things I picked up on, you talked about is mentoring. You mentioned that a couple times, importance of mentoring and also your tribe or your village, however you wanna refer to them. is really important, the people that you hang out with, and it can help shape your future. And I'm sure even today, it's really important. And we talked some about care redesign, patient experience. I loved how you were talking about empathy's table stakes. What we really got to focus on is what makes it easy for the patients. And then we talked about how can you best interact with sort of digital or tech leaders. Is there anything we missed or Anything you want to double down on, I'll give you the last word.

Oh, I appreciate that. You know, I think what I want to double down on is that importance of relationships.

Yeah.

There's no healthcare without relationships. That's really central to our value proposition. But as we transform and change our organization, that relationships with our peers, with, you know, up, down, sideways, That's what really makes the world go around. The better we get at that, the more we invest in building those bridges with others, the more successful we're going to be.

Yeah, very well put. Judy, this has been fascinating. Thank you so much for spending time with us on Digital Voices.

Thank you so much for having me, Ed. Thank you for listening to Digital Voices podcast with Ed Marx. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening. Thank you.