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 for Swedish Medical Center in Issaquah, Washington.
During her tenure, her focus on growth, transformation, and stewardship brought improved performance outcomes that endured the impacts of COVID-19. Board certified in physical medicine and rehabilitation and subspecialty certified in neuromuscular medicine, Arnold held a variety of clinical and leadership roles across Swedish Health Services, including Regional Executive Medical Director of the musculoskeletal service lines.
As a key member of St. Mary’s leadership, Dr. Arnold will work to improve both patient and caregiver experience and grow the high-quality, high-value care provided to Grand Junction and its surrounding communities.
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State of Reform: As Chief Medical Officer at St. Mary’s Medical Center, what is your vision for the hospital as the Grand Junction community looks to recover from the pandemic?
Michelle Arnold: “Obviously, ongoing care for our sick patients who contract COVID will undoubtedly continue. That’ll be in conjunction with the many other contagious [and] infectious conditions that we treat on a regular basis. We learned a lot during COVID and we get to take all of the lessons and bring that into our post-pandemic future. The one that comes to mind most readily is that of telehealth and telemedicine, which will continue to be a welcome extension of in-person care. This is something we advocated for for a long time before COVID. [The pandemic] was really the accelerant to this positive change for all of us.
The other one that comes to mind is our infection prevention programs. They’ve become highly capable and they’ll continue to be a resource for the next wave of whatever may come.
The other one that I was involved in during COVID was incident command, and our hospital leaders have now grown more adept at the incident command structure. We’ve moved into this mode of continual readiness. The medical teams actually really froze during COVID. Clinicians that worked together through [the] dark days of COVID seem to emerge with this new passion and are better equipped to coordinate care.
Then the ugly side is that burnout continues to be a problem and has risen through the pandemic. Here in our post pandemic future, we’re grappling with more than 50% of clinicians who admit to one or more elements of burnout. It’s the most significant workforce disruption of my lifetime and staffing is going to become a focus for years to come. From a social standpoint, there’s this growing mistrust of authority, including [for] health care workers. People often don’t know what or who to believe. And so transparency and integrity will be key pieces to rebuilding that trust. I believe that the place for this truly to take place is one-on-one, patient to clinician relationally at the bedside or in the clinic, and that’s actually my greatest hope for our health care future is in that restoration of trust, starting with that relationship.”
OR: What are the immediate needs of St. Mary’s Medical Center and its patients? How can federal and state reforms support those needs?
MY: “So speaking of burnout, caregiver wellness is really the big response and remains the focus of health care systems. We need to quell the attrition and turnover. Just today, I was in a nursing meeting not an hour ago and heard stories about the silent quitting. Burnout is really leading to a lot of dissatisfaction.
Caregiver wellness is going to be an important focus and we have programs here, but I think this is so universal that it’d be really nice to have some statewide and federal support for caregiver wellness initiatives. We fully support efforts that continue to ensure the ongoing protection of our caregivers and we have a lot of resources, but I think it’s still not enough.
Another piece is around reimbursement. There’s this growing mismatch between health care reimbursement and just the plain old cost of doing business. Things like durable medical equipment and supplies and labor, they rise alongside inflation but even at a faster rate. Meanwhile, reimbursement to health care providers has been in a consistent decline for more than a decade. There’s intense pressure on hospitals to develop efficiencies and curb costs. So we do supply chain management and we try to improve our workforce productivity, but ultimately it’s going to come down to care redesign. That’s going to ensure our sustainability and that can be a disruptive place to go.
It’s like trying to build the plane while you’re flying it, and we are constrained by various regulatory demands that make it difficult for us to sometimes be agile. Efforts toward care redesign will be really important. Then [there are] our workforce constraints. Here at St. Mary’s, we’re continuing to utilize staffing agencies or travelers to help fill gaps and that leads to a lot of higher labor expenses. Recruitment in our community and our geography can be really challenging, especially for physicians and advanced practitioners.
Training programs need to use predictive modeling to help assess the current and future workforce needs, so that we can serve our community, particularly around nurses, physicians, therapists, behavioral health professionals, techs, aides, pharmacy staff, and laboratory personnel. Those have been really challenging. Training programs ramping up and then apprenticeship programs could be an opportunity that we could explore to help fill gaps until those trainees actually enter the workforce.
Then finally, the socioeconomic challenges of today come to mind. Basically, patients in our community are facing increasing social and financial pressures and so particularly vulnerable are our aging seniors. They lack adequate support. We have persons who don’t have a home to live in, those who are in transitional housing, [and] people suffering from behavioral health conditions or substance use or dependency. These are our most vulnerable in our community.
Of all the things that I could magic wand, regulatory efforts and or financial incentives that widen the safety net for our most vulnerable, that’d be the thing to fix.”
OR: Can you speak to programs or initiatives that address accessibility and equity for rural and underserved populations?
MY: “One of the big efforts is to partner with other local hospitals and critical access hospitals, clinics, [and] post-acute care facilities to provide that primary care and specialty care, surgical care, intensive care, [and] trauma services to our community and beyond. Efforts are ongoing to expand the interoperability of our medical records. That obviously facilitates safe and secure sharing of health information for care coordination across the sites and specifically into our rural communities.
For example, we currently host our electronic medical record [called] Epic for Craig Memorial Hospital. We’re looking at other ways that we can ensure interoperability of the medical record as a good starting point for good communication. Second—this is an Intermountain initiative as much as it is a St. Mary’s initiative—and that’s patient dignity …
There’s ongoing caregiver education around patient dignity, and we’re exploring our own implicit bias and the hope is that we can ensure inclusion for the health care of all individuals that are in our service area, focusing on inclusion and ensuring patient dignity.
Then finally, our community health needs assessment process is the means by which we look for specific programs and services and how they might fill needs in our immediate community, not just in our community, but in our secondary and tertiary service areas reaching out into those rural communities.
That’s what we use to help inform our recruiting efforts. It helps us right-size services to ensure that we have accessibility for all those needed services. It has been difficult during the pandemic because resources have been scarce. But we’re continually measuring and monitoring our wait times and we’re re-examining ways where we can streamline our processes and improve patient access and health outcomes.”
OR: How is St. Mary’s working with stakeholders to prepare for the end of the Public Health Emergency?
MY: “The biggest issue 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 newer entity looking at not just delivering good, safe, quality care, but doing so in an affordable way. We’re trying to take this community approach to reduce the social determinants of health. And that takes a lot of purposeful coordination among all the different hospitals in the system, but also with some of the community organizations and the folks right around us here so that we can create a healthier population.
We’re trying to streamline some internal processes, we’re trying to reduce unnecessary waste and duplication in the system. As you might imagine, when you’re trying to integrate two disparate health care systems, even though we’re really tightly aligned around mission and values, we do have some duplication and so working to eliminate that helps streamline and deliver care in a more cost-effective way. That’s work that we’re going to continue moving forward in kind of this post-pandemic integration phase that we’re navigating.”
This interview was edited for clarity and length.