By Chris Motola
Fulton native is now Oswego Health’s hospitalist medical director — he talks about his new position and his focus on quality, safety and patient satisfaction
Q: You’re an Oswego County native, but how long have you been back home working with Oswego Health?
A: I’ve been a provider for about a year and half. I have kind of a long history with Oswego Health. I’ve been a patient there and there were a number of programs that I engaged with over the years. There was a program in the lab that I was involved with in college, and then in medical school I did the rural health program at Oswego Health. When I finished my residency in Syracuse, I came here to practice. So I’ve been a hospitalist with Oswego Health for about a year and a half. And then I picked up the role of hospitalist medical director last September.
Q: Did you have your sights set on the role or did you more fall into it?
A: A little bit of both. I’ve always gravitated toward leadership positions. I was in leadership positions in medical school and residency, so it always seemed kind of like a natural progression. And then it just fell into place. We needed a new leader, the position was open and with my background in quality — quality is very important to Oswego Health right now — it was kind of a natural fit.
Q: Can you go into your background in quality a bit and what that entails?
A: The bulk of my quality experience was during my chief year. I did the chief resident program for quality and safety. It’s not specifically for hospitalists; you can be from any subspecialty. So it’s a year where you’re also looking at quality at the Syracuse VA Medical Center. Whether that’s length of stay, process initiatives, metrics for a wide variety of domains.
Q: For those of us who may be unfamiliar, what is a chief resident?
A: All specialty chief years are a little bit different. So they either, in your last year of residency or an additional year—mine was an additional year, which is typical for hospitalists. Mine was focused on quality and safety, but I was also an attending who interacted with the residents directly. Chief years can be almost entirely administrative, where you’re designing the schedule, but mine was less focused on that and more on maintaining the quality of the hospital and transitions between the VA and SUNY Upstate because our residents were moving between the two hospitals.
Q: What kinds of quality indicators are a priority for a rural network like Oswego Health?
A: I think with all hospitals there are institutional quality goals and patient-centered quality goals. Certainly patient satisfaction is important to us and we monitor that. I think efficiency, which goes along with quality, is very important for small, rural hospitals. Resources are more limited. We’re always trying to get more providers, more subspecialties. Nursing staff resources are limited. So efficiency really comes into play. Length of stay has been one of our metrics that we’ve really focused in the past year. I think that allows us to try to improve across a number of domains. Length of stay is important for the hospital, but it’s also important for the patient. They want to be in the hospital for the shortest amount of time possible. By shaving off the amount of time they’re there, we’re reducing the cost to us in resources, which in turn allows us to treat more patients, and make sure the care that we’re giving is the best possible.
Q: Does being based in a college town affect continuity of care given the transient population? For tracking some indicators?
A: Over the care spectrum it might, but we don’t see a lot of college students overall. Most of our patients are longtime members of the community. I think we’re in a somewhat unique position in that we have good relations with our outpatient providers and we’re always working on improving our relationship with them. So I’ve been going out into the community to speak with the outpatient practices to develop connections. I think we recognize that hospitalist medicine can’t really be practiced in a vacuum. We want to connect the dots between being an inpatient and an outpatient and make sure the transitions of care are effective.
Q: I understand you have an interest in orientation and gender identity healthcare. What kinds of resources can Oswego Health offer in that domain?
A: Being sensitive to all demographics is important so that people feel comfortable seeking treatment. All populations have a lot of the same illnesses and comorbid conditions, but social factors do need to be taken into account so that people are comfortable. We offer bread and butter medicine to all populations, but I think connecting gender medicine and sexual health medicine to the resources they need—usually in Syracuse-area hospitals or outpatient providers—is important too. So we can kind of springboard a lot of those patients to the providers who can get them the care that we may not offer.
Q: What’s the low-hanging fruit, do you think, in terms of indicators that can be improved at Oswego Health going forward?
A: I think patient satisfaction has been big for me and it’s probably one of the easiest to accomplish. We’ve just renovated the inpatient wards. We’re fully staffed with some very experienced, very good hospitalists. I haven’t been in the position long, but I’m hearing this is one of the strongest hospitalist teams that we’ve had. So that allows us to make the patients’ experiences better and making sure the communication they’re receiving is better and that it gets passed on to their primary care providers. At the end of the day it’s about the patients, full stop. And that’s where we can be most effective.
Name: Nicholas Runeare
Position: Hospitalist medical director at Oswego Health
Education: SUNY Upstate Medical University
Affiliations: Oswego Health
Organizations: American College of Physicians
Family: Partner (a nurse at Oswego Health)
Hobbies: Skiing, cooking