Scripps Health CMO Shares Top 4 Priorities for 2024

Anil Keswani is focused on organizational goals including promoting operational excellence and patient engagement.

Supporting efforts to bolster Scripps Health's financial standing is the top priority for the health system's chief medical and operations officer for ambulatory care.

Anil Keswani, MD, has been corporate senior vice president and chief medical and operations officer for ambulatory care at Scripps since February 2020. He was previously corporate vice president of population health and president of Scripps Executive Health.

1. Financial health of Scripps

The top priority for Keswani this year is promoting the financial standing of Scripps. After the coronavirus pandemic public emergency, many not-for-profit health systems have been struggling financially, he says.

"We are looking at making sure we are fiscally responsible and financially strong to keep providing care," Keswani says. "This is a big issue in California because of the state Office of Healthcare Affordability. To meet this state agency's targets, we are going to have to manage our costs appropriately."

One area where Scripps is seeking to contain costs is the purchase of new equipment. For example, surgeons requested the purchase of new robots for operating rooms, but the health system conducted a robot utilization review and found that a surgery robot was not being used to its full potential at one of Scripps' hospitals, he says.

"With some operational changes and some clinician changes with how we schedule procedures, we were able to improve our robotic utilization across our health system to the point where we were optimizing that asset," Keswani says. "Had we not done that, we would be buying more robots and underutilizing them. Optimizing the use of our assets contains costs."

Scripps has also enlisted physician leaders in cost management efforts, he says. The health system has formed the Medical Equipment Capital Advisory Group, which includes physician leaders and operational leaders, to look at the purchase of capital equipment on both the ambulatory and acute-care sides of the organization.

"These experts are prioritizing our capital expenditures, which bubbles up to our C suite, and we make sure we are utilizing our assets appropriately," Keswani says. "It involves a lot of education and communication so our leadership can understand how to invest in the right equipment."

Anil Keswani, MD, corporate senior vice president and chief medical and operations officer for ambulatory care at Scripps Health. Photo courtesy of Scripps Health.

2. Operational excellence

Keswani's second priority for 2024 is promoting operational excellence.

"When you talk about operational excellence, people typically think about staffing appropriately and using resources appropriately," he says. "What we need to figure out now is how artificial intelligence plays into operational excellence."

One of the things Scripps is doing this year to foster operational excellence is using ambient technology to produce AI-generated notes of clinical encounters that clinicians can review.

"Gone are the days when doctors were typing on the keyboard throughout a patient encounter," Keswani says. "We are moving to the next stage, where clinicians are able to talk face-to-face with patients, then generate a clinical note with AI."

Scripps is also using AI to help clinicians manage in-basket messages from patients, he says. Clinicians receive thousands of messages from patients, and the health system is using AI to help construct return messages.

"We have started to use AI to construct a first draft of a message back to the patient," Keswani says. "If a patient emails a doctor with a question, we are using AI to create a first draft of a message that tees it up for the doctor or nurse to review and edit, then they can send the message to the patient."

3. Care access and patient engagement

Keswani's third priority for this year is supporting a care access and patient engagement program that Scripps calls "Getting to Yes."

During the pandemic, barriers were erected in the interaction between healthcare providers and patients, Keswani says.

"There were literal barriers such as Plexiglas walls between us and the patients," he says. "Over the past few years, we have pulled back from the patient. When we had a patient surge during the pandemic, patients had to see us through telehealth."

Getting to Yes is a philosophical change and a change in care teams' attitudes so they embrace patients, Keswani says.

"Getting to Yes encompasses access and experience, but it is also creating personal accountability to connect with our patients the way we wanted to prior to the pandemic," he says. "This is more than a tag line. We want to make sure that we stay true to our organization's brand, which includes being a high-quality experience provider for our patients."

One Getting to Yes initiative has been replacing the health system's call center for patient phone calls with a hybrid contact center model, Keswani says. In some cases, patient phone calls are directed to clinical care offices, but in most cases, patient phone calls are directed to the health system's contact center.

"We have an on-site contact center, where we monitor metrics and how the staff is operating," he says. "At the contact center, we have highly skilled customer service representatives who check each other's work."

Health systems and hospitals have high turnover among customer service representatives, which affects the quality of patient engagement, Keswani says. Scripps has addressed this challenge by letting most customer service representatives work from home part-time.

"We have taken a percentage of the people in the contact center and let them work from home," he says. "Then they rotate into the contact center one week per month. We have found that the staff is excited to come into the contact center for one week, and they have an engaged attitude."

4. Engaging and developing staff

Keswani's fourth priority for this year is staff engagement and development.

Scripps has been named to Fortune magazine's 100 Best Companies to Work For list 16 times.

"The award is nice, but it reflects that we have a good relationship with our frontline people," he says.

The healthcare sector is going through a challenging time, and Keswani wants to make sure he is engaging staff members, he says.

"With an inordinate amount of change, we need to keep our clinicians with us," Keswani says. "We want to make sure they are part of the changes and understand the changes. We make sure that we keep our staff educated and informed as well as aware of the decisions that we are making."

One of the ways Keswani engages his staff is sending out a weekly "highlights" email to hundreds of people in his leadership structure.

"The email talks about what is happening locally, what is happening nationally, and what is on my mind," he says. "It is important to be connected with your staff."