Tragedy at home takes precedence for 2017 Harwick Award winner

For Peter Valenzuela, MD, MBA, CMPE, MGMA member, chief medical officer, Sutter Medical Group of the Redwoods, Santa Rosa, Calif., the traditional fanfare for winning the MGMA Harwick Innovation Award was cut short.

Around 3 a.m. Oct. 9 — just hours after arriving in Anaheim, Calif., for the MGMA 2017 Annual Conference — Valenzuela got a call about an approaching fire in his neighborhood. As the day continued, neighbors relayed just how bad the situation was. It was clear that he needed to return home, but conditions in Southern California posed additional difficulties: A fire near Anaheim contributed to his flight being cancelled.

Valenzuela and his wife rented a car and drove as far as San Luis Obispo before learning that mandatory evacuations would prevent them from returning home, and that his mother-in-law — who lives with them and had a caregiver assisting her — would need to leave the home.

That fire was one of several that affected more than 245,000 acres, destroyed more than 8,000 buildings and killed 43 people — the deadliest week of wildfires in California history.

Valenzuela stayed in a vacation rental for two weeks and was eventually reunited with his mother-in-law. Meanwhile, he worked through Sutter’s incident command protocol, which included four calls a day to keep track of staff members and their safety.

For Valenzuela’s medical group, the physical damage was limited to only one of its 13 facilities — the biggest ambulatory facility, which took Sutter from 250 total exam rooms down to about 160 for the group’s 130-some physicians.

“It has been really painful for us in the interim. … Our group right now is about 60% of what we were before. We’re busy at that 60%, but the bad news is we don’t know what the overall impact will be because we are not at 100% yet,” Valenzuela said. “It’s tough to assess whether we will have a decline in volume over the next three to six months or over the next year, or if we will be back to normal.

“It’s been devastating … but we’re making do,” he said.

Part of that recovery is owed to the implemented step-by-step plan. Within a week of the fire, the group prioritized the reopening of care centers and triaged which patients had the most urgent needs — including oncology patients and patients in need of post-operative care — before returning to the full range of primary care.

Along the way, Valenzuela said the group got creative to make its emergency management protocol work for the specifics of the fire, partnered with other groups in his network to arrange telehealth visits for patients and used ride-sharing services to provide transportation to patients without means to get around.

“Our docs have been more than willing to do anything we ask of them,” Valenzuela said. “I’ve got a neurologist working in one room next door to a cardiologist, next door to a rheumatologist, next door to a primary care physician, and not one of them is complaining about it.”

A reason for that camaraderie is what led Valenzuela to win the Harwick Award in the first place. Before natural disaster disrupted things for Valenzuela, his medical group had spent four years developing, implementing and refining plans and programs for a unified culture and improved staff well-being after a period of growth that brought in many private practice physicians.

The plan began with addressing professional aspects of work, including a mentoring program, employee recognition, leadership development and continuing medical education. Next, the group looked at personal aspects of employees in the care centers — which included offering funds for people to travel overseas to provide medical care and then share their experiences upon return with the rest of the group.

Finally, the group addressed the social aspects of employees by adding communal activities such as wine tastings, group hikes and a movie night for physicians and their significant others at a local theater.

The resulting return on investment? In the past four years, Sutter has  seen a 21% increase in provider satisfaction and a 17% increase in meeting attendance by providers, while maintaining high marks for patient experience (above the 90th percentile for the state of California), quality of care (a top-performing physician group as designated by Integrated Healthcare Association) and performance. The group also has seen a fourfold improvement in timely chart closing and a threefold increase in patient referrals after implementing an EHR optimization.

Valenzuela credits the cultural change and awareness of physician and staff well-being as reasons that the group responded so well after the fire.

“We had 16 total physicians and clinicians who work with us lose their homes. … Within three days after the fire, a lot of them were already back at work in the care centers, just taking care of patients,” he said. “It wasn’t us saying, ‘You need to come back immediately.’ It was them saying, ‘I really need to take care of my patients, and I can’t let my colleagues down.’

“The disaster has been terrible, but it also has been unifying for us and reinforced that if we did not have this plan in place, I can only imagine what the response would be from our [staff],” he said.