When Charlotte, N.C.-based Atrium Health and Advocate Aurora Health, then dually based in Downers Grove, Ill., and Milwaukee, completed their 2022 merger, the organizations created Advocate Health, one of the largest nonprofit health systems in the country.
The 69-hospital system has more than 162,000 employees and provides care for about 6 million patients across Alabama, Georgia, Illinois, North Carolina, South Carolina and Wisconsin. Winston-Salem, N.C.-based Wake Forest University School of Medicine serves as the system’s academic core.
After almost three years since the merger, Advocate has begun appointing leaders to help establish national service lines for cardiology, neurology and oncology.
At the helm of the cardiology service line, called the Advocate Health Heart and Vascular National Service Line, are Geoffrey Rose, MD, and Ginger Biesbrock, DSc, PA-C, who serve as president and senior vice president, respectively.
Dr. Rose and Ms. Biesbrock spoke to Becker’s about the strategies and priorities driving standardization across the service line, and why cultural alignment is crucial to advancing clinical care.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What external forces led to the creation of the Advocate Health Heart and Vascular National Service Line?
Dr. Geoffrey Rose: One of the challenges with healthcare in the United States is that there’s a high degree of variability. There’s a high degree of dependence upon where you happen to live, which dictates what is available to you. It’s just a function of how medicine became organized over time.
As we’ve become a large healthcare system, we recognized the opportunity to be able to deliver the best of care independent of where people happen to live. So geography is not destiny.
As a system, how can we meet the needs of our patients? A national service line becomes a vehicle to distribute that expertise back to the patients in their home community. That’s our aspiration, and that’s our why.
Ginger Biesbrock: The concept for the service line is to create an organizational structure for both leadership and management, and, most importantly, a care delivery structure across the full continuum of care.
With a large geographic footprint, we are creating a model that assures we have the right care in the right place, allowing us to tie the ambulatory side across through on the acute care side. That’s part of what we’re building here, a model that takes into account that entire continuum.
Q: What are your top priorities for growth and integration?
GR: We’re really privileged because we’re starting from a very high bar of clinical quality and capability. To be able to deliver this type of care there has to be a strong degree of cultural integration and alignment. Ensuring we’re all seeing the world the same way, prioritizing the needs of our patients, recognizing that we are human beings taking care of human beings. We have to be thinking about the workforce and how we fortify and sustain that.
Then there’s a fundamental commitment to identifying and implementing best practice. If you have an association of like-minded people who ascribe to those things, then it becomes a much easier path. Invariably, there’s going to be opportunity in a location or region, for some element of improvement or advancement.
If you’ve got a cultural alignment of people who are inquisitive, open and willing to adapt, you can really bring the best of practices to a broader scale. Then it becomes an exercise in seeing where the greatest need for a particular change is and going through the change management steps.
GB: We’re beginning to create venues in which we can bring our clinical experts together to start to collaborate, coordinate and share.
One of the things that comes out of it is the identification of best practices, where we’ve maybe tried some things in certain markets that have gone well, and other markets are interested in implementing something similar.
What’s fun and exciting about this is to see the physicians come together in a way to start to share those things. We’re concentrating that clinical talent first and then adding the administrative leadership support piece to help implement and execute those best, agreed upon practices across our enterprise.
Another thing we’ve done is become innovative and early adopters of new cutting-edge technology. We can be very deliberate about where the best places are to maybe get involved in some of those early access opportunities to different or new procedural technologies, try them, and then learn from each other very quickly.
The system has done a very nice job with bringing the data together, so we have good access and line of sight to performance — clinical, operational, financial data — across our enterprise.
Q: How are you building and sustaining alignment among cardiologists, surgeons, advanced practice providers, researchers and administrative teams across multiple regions and diverse sites of care?
GR: No. 1, the people we bring into the organization have to be wired to collaborate. The tendency, the desire, the capability to coordinate is really a foundational and fundamental quality we look for.
No. 2 gets into some elements of organizational structure.
We have a regular, organized meeting of what we call our heart team — cardiac surgeons, our imagers, our interventional cardiologists, critical care — to discuss complex cases and navigate what the right path ought to be.
What started as an initiative is now just part of our culture, this is what we do. This is how we take care of patients. This is how we think about things. We make better decisions that way, but also it brings us together across the board.
No. 3, aside from clinical care, is defining the scope of the service line. When we’re in the hospital, what happens to a patient 30 days after their stay is not somebody else’s problem. It’s our collective responsibility.
We have a collaborative approach because the responsibility is focused on the patient, the patient’s needs and the patient’s journey, not where they happen to sit at one moment in time.
GB: The goal of the service line is to create a horizontal alignment. We’re all responsible for the outcome of these patients, for the experience of our patients together, the experience of our teams and our caregivers together, and the overall quality economics, cost-effectiveness of the care that we’re delivering.
As a service line leader, our responsibility is to tie all of that in in a horizontal way, so that our teams understand how their work is congruent with those shared responsibilities, no matter where they are across that continuum.
Creating that common purpose, common relationship. We’re all taking care of the same patients, even if we’ve been touching them a little bit differently. How do we start to tie things together so we can work in more of an orchestrated way with each other and with a common purpose of providing high-quality cardiovascular care to our patients.
Q: How is Advocate Health leveraging digital tools and data to advance precision cardiovascular care?
GR: Being organized with one EMR across the system, and because of the sheer number of encounters we have as an organization, we’re able to leverage data in unique ways. That has been a great asset for us initially, and now beginning to apply AI tools to those data sets.
With respect to cardiovascular medicine, there’s a wealth of materials in the remote monitoring space and ECG space and other physiologic data that maybe we don’t see in other specialties. That really does lend cardiology to big data assessment. More to come on that from some of the projects that we’ve already put out.
GB: Key to being a large system — we’ve been able to harness data to pilot new care pathways and environments, find the right technology platform, identify the appropriate workflows and prove the changes are creating the outcomes and the benefits that we’re looking for. Then, through system initiatives, we can begin to execute those changes across our entire enterprise.
We’re learning to get really good at identifying early adoption opportunities, and then quickly learning from each other and spreading that care model or technology across the system.
GR: Not only do we learn from each other, but we’re able to share those learnings with the broader cardiovascular community. For example, pulse field ablation. We had done well over 1,000 cases before many of our contemporaries had stood up their programs.
We were able to publish on that, so hopefully, the uptake of others around what we think is an advancement for all patients could happen more quickly.
It’s not just about serving our patients and learning from each other, but it’s the extra dimension of having a broader impact on the field that becomes a function of our scale and our ability to cooperate inside our service line structure.
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