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CMO reports progress on culture, management systems and falls reduction at extended care center
Summary
Chief medical officer Brian Evans briefed the board on the CMO role, efforts to align and hold medical staff accountable, management‑systems projects using process improvement, and a falls‑reduction effort at the Extended Care Center that reduced fall rates after environmental and standard‑work changes.
Tahoe Forest Health System's chief medical officer, Brian Evans, briefed the board on Feb. 27 about the scope of the CMO role at a small integrated health system, efforts to improve culture and accountability among employed medical staff, and examples of management‑systems process improvement that the system is using to address operational and clinical quality problems.
Evans told directors the CMO role at Tahoe Forest differs from hospital‑only CMOs because the district directly employs most physicians and operates multiple outpatient and inpatient sites across two states. He said the role involves credentialing oversight, clinical quality and safety, and coordination across 27 service lines.
On culture, Evans said the system has “made significant improvement” but still faces challenges because the organization has grown rapidly and moved from independent to primarily employed physicians. To measure clinician well‑being, he referenced the Mayo Well‑Being Index and said burnout remains “a significant problem.” He told the board the system has a range of wellness resources and will measure changes with another survey in May.
Evans described two management‑systems examples. In pediatrics, staff used process‑improvement tools and an A3 problem statement to pilot changes to Saturday clinics to address underutilization and staff scheduling burdens; the pilot will be monitored against measures such as urgent‑care volume and staff engagement. In the Extended Care Center (ECC), teams investigated a higher‑than‑expected resident fall rate, identified environmental contributors including dark floor tiles, and applied a mix of physical changes and standard work for staff; Evans said falls have come down since those interventions.
On accountability, Evans acknowledged the difficulty of aligning medical staff and enforcing standards in an employed‑physician model but said the system has elevated medical directors and increased transparency; he said an outside consultant (ECG) will help with physician employment and payments. Evans also noted a recent physician death in the South Lake Tahoe area and said it underscored the importance of continued focus on clinician wellness and support resources.
The CMO report did not require board action; Evans encouraged directors to visit units where A3s and improvement projects are posted and said the system intends to continue expanding management‑systems work.
