239: Saint Francis' CMO Dr. Reetu Singh: Why to Shop for Digital Tools the Way You Shop at Home Depot, the Hidden Cost of Standardizing Patient Care, and the Signal That Beats Every Dashboard Metric

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On this episode of The Digital Patient, Dr. Joshua Liu, Co-founder & CEO of SeamlessMD, and colleague, Alan Sardana, chat with Reetu Singh, MD, FACHE, MBA, CPHQ, Senior Vice President and System Chief Medical Officer at Saint Francis Health System, about "Why to Shop for Digital Tools the Way You Shop at Home Depot, the Hidden Cost of Standardizing Patient Care, the Signal That Beats Every Dashboard Metric, and more..." Click the play button to listen or read the show notes below.
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Audio:

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Guest(s):

• Reetu Singh, MD, FACHE, MBA, CPHQ, Senior Vice President and System Chief Medical Officer at Saint Francis Health System
• Joshua Liu, MD (@joshuapliu), Co-founder & CEO at SeamlessMD

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‍Episode 239 - Show Notes:

[00:00:07] Episode preview

[00:06:13] Why clinical excellence at the bedside stopped being enough — in medical school, Dr. Singh would have told you she was going into medicine to take care of patients and would never leave the bedside. There was no single turning point, but it became obvious that being a good clinician was no longer sufficient. "We truly need to change the system, and the system of healthcare delivery has to excel for a clinician to excel." That realization pushed her to get into the meetings where decisions affecting her own patient care were being made.

[00:07:34] How she ended up in the CMIO role during the meaningful use era — she was at AdventHealth when the CMIO role opened up, at a time when everyone was being required to move to an EMR and she was hearing significant frustration from her peers. She was better with the technology than her colleagues and took the role because she wanted the people she worked with to succeed: "that's the only way we will survive the changes we are having in healthcare."

[00:08:24] Why a CMO can never fully leave informatics behind — Dr. Singh still works closely with the CIO, clinical informaticists, and the chief nurse on workflow redesign and how technology lands on physicians and patients. The CMIO role taught her that technology isn't separate from care delivery, it's part of the continuum. CMIO and CMO are appropriately distinct roles in most health systems given scope, but the work is intertwined. What healthcare is really solving for with technology, she says, is "humans caring for humans" and making limited resources more efficient without giving up patient-centric, safe, high-quality care.

[00:10:38] How to respond when patients arrive with answers from ChatGPT — she tells clinicians to embrace the technology rather than fight it, and when patients bring in what they've seen on ChatGPT or Google AI, to redirect them to resources the clinician considers authentic. Used well, she expects it to drive better medication compliance, better-prepared patients who know what side effects to expect, and better questions in the room. With access an issue across America, a patient who has waited for an appointment wants to arrive prepared.

[00:12:34] The Home Depot test for evaluating digital solutions — an analogy from a recent conference that stuck with her: nobody walks the aisles at Home Depot thinking "that tool looks nice, where can I use that?" Something is broken, and you shop for exactly what fixes it. "Technology has to win and has to really fit in and earn a place in a clinician's daily workflow. And if it doesn't, it doesn't. It might solve someone else's problem, may not solve your problem today."

[00:14:15] Why workarounds tell her more than awards or metrics — Saint Francis has earned system-level quality recognition including a CMS five-star rating, and she says validation matters because people want to be recognized for hard work. But numbers are lacking. When she rounds and hears consistently that there's a workaround, that's the signal she looks for: what's in place isn't working. In a large health system, workarounds mean care isn't consistent, and that leads to a bad outcome soon enough. She credits the awards to culture rather than the reverse.

[00:18:32] How a locally operated system prepares its culture for change that keeps accelerating — Saint Francis is locally operated and governed, so decisions don't route to a centralized out-of-state office. Managing change comes down to accountability and involving people in the decision-making, because ownership dissolves the resistance you'd otherwise get. "You cannot take decisions in silo." Most large changes carry a dyad partner in operations who is a clinician: "You would not attend a meeting at Saint Francis that would impact a clinician and there weren't multiple clinicians at the table."

[00:20:34] What must be standardized and what should be left to local autonomy — quoting CEO Dr. Robertson, "there's no standard patient," so full standardization isn't possible. The system standardizes the what and the why; the how is left to clinicians, because care is delivered locally and it's called practicing medicine for a reason. The line she draws: the critical steps everyone agrees would lead to a bad patient outcome if left inconsistent must be standard, and everything else should be left to clinician judgment.

[00:22:20] The most overrated way health systems talk about digital transformation — standing in front of clinical staff and announcing "we need to have clinical transformation across the health system" means nothing. What exactly wasn't working that you're trying to improve? Instead, know your three- and five-year goals for access, experience, and quality, and work backwards. Keep it bite-sized rather than boiling the ocean, and let subject matter experts guide what operations does next. Her closing point: "Clinical outcome, then clinical care delivery should guide the budget," not budget driving clinical decisions.

[00:24:54] How patient stories connect the departments that never see a patient — two years into a high-reliability journey she describes as a journey rather than a destination, she says non-patient-facing departments need to feel connected to why the organization exists. New employee orientation is run combined across all departments and led sometimes by an operational leader, sometimes a clinician. At a recent finance town hall she presented the VTE program and a patient whose massive saddle PE was removed and who went home the next day, and watched the twinkle in the eyes of a team that never gets to see that. Same with the new ECMO program and the path to heart transplant: you did the pro forma, and here's a patient who walked out with an LVAD when that was their only option. "I think you have to connect the dots and pull the system together."

[00:29:16] Why documentation is both essential and the number one driver of burnout — documentation matters for continuity of care, handoffs, data collection, and patient access to their own records, which patients now see as soon as it's entered. But as a clinician who still practices, she says it has become burdensome: too many things get documented that may or may not affect patient care, driven by compliance and state, CMS, and Joint Commission requirements. "That is the number one reason for burnout," and documentation is where she's most hopeful AI and digital innovation will save clinicians.

[00:30:50] What it means that physicians are retiring over documentation burden — she's heard directly from physicians who left practice because of it, and says it makes her genuinely sad. In a country already short on people entering medical school, nursing school, and advanced practice training, with a larger shortage arriving in five to ten years, losing clinicians who are doing the job today to paperwork is untenable. Solving it with AI and technology is now one of the health system's strategic initiatives.

[00:31:58] How health systems unintentionally betray clinician trust with new tools — "we have to manage that change with the clinicians and not to them." What looks good in a boardroom may not look good to the clinician who has to use it, so end users have to be brought in early, whether you're evaluating a product or building with AI yourself. There has to be a subject matter expert for the problem being solved. Her framing on builders: "nothing against builders or technicians or engineers, but they're not clinicians. It's like I'm not going to build a tool and ask a lawyer to use it."

[00:33:02] Why clinicians share the blame for the tools they inherited — she says clinicians can take ownership of not giving feedback when the technology was being developed 20 or 30 years ago, and the fix going forward is "the feedback is in the right place at the right time by the right expert." She's hopeful about where this is heading: the last 10 to 15 years have produced something she calls revolutionary, unlike the products of the early 2000s, and the current generation entering medical, nursing, and engineering schools is arriving with the experience of something not working for their own family. "This generation has to get it right."

[00:36:21] The signal she trusts more than any dashboard — informal hallway conversations, the physicians lounge, and walking the floors with nurses. Waiting for metrics and outcomes means you've already missed the boat, because those lag. Her favorite tell is the clinician who says "I was looking for you, but don't worry, I figured it out" — either the fix belongs in the process, or the person was simply high-functioning enough to route around it. Either way: "we need to solve for the weakest link on the team, because the next time when someone else has that issue, you don't want that ball to be dropped." She notes people are far more forthcoming in their own environment than when they've booked time in your office.

[00:39:40] What she would challenge a room of CMIOs to do differently — rather than name something to stop, she'd redirect the focus: "we need to design systems that truly support clinicians and improve their quality of life, and eventually leads to better patient care." That means not chasing the shiny object heard at a conference and looking for somewhere to install it. Go to the conference with a list of problems your clinicians need solved, and shop against that list. "Just listen to your physicians and support your clinicians is what I would say."

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‍Fast 5 Lightning Round:

1. What is your favorite book or book you’ve gifted the most?
   Becoming by Michelle Obama.
2. If you could instantly master any skill, what would it be?
   "Making people feel better."
3. Would you rather have Super strength, super speed, or the ability to read people’s minds?
   "Honestly, none of them. If I could read people's emotions a little bit better, I would love that."
4. What is something in healthcare you believe others might find insane?
   "We need to send more people to medical school."
5. What is the last movie or TV show you saw, and what did you think of it?
   "The Greatest Game Ever Played... Great story of resilience and determination and what humans can achieve if they put their mind to it!"

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