Transforming physician and APP experience at San Juan Regional Medical Center

Coauthored by Dr. Robert Underwood, Chief Medical Officer, San Juan Regional Medical Center.

Press Ganey's "Healthcare employee experience 2025" report reveals a clear reality: Physician and advanced practice provider engagement and alignment are on the decline nationwide. Clinicians are under immense pressure to deliver high-quality care and service while juggling rising volumes, cost constraints, and constant regulatory shifts. At the same time, many are navigating fragmented communication, weak cross-functional teamwork, and persistent operational roadblocks.

While some organizations are still deciding how to respond, others are moving forward—with urgency and intention. They recognize that the cost of inaction is too high, and that solving for engagement starts now. 

Take San Juan Regional Medical Center (SJRMC), a 198-bed community hospital in Farmington, NM, which is putting transformation into motion. Under the leadership of President and CEO Jason Rounds and Chief Medical Officer Dr. Robert Underwood, the organization has taken bold steps to engage its physicians and advanced practice clinicians in meaningful dialogue and action. After being hit hard by COVID-19, SJRMC chose not to wait for change—instead, they leaned in, listened deeply, and committed to supporting their caregivers in real, lasting ways. Yes, the road has been challenging, and the work is ongoing. But their dedication to growth and improvement remains unwavering.

Below, Dr. Underwood reflects on the progress made—and the path ahead.

In the CMO’s own words: Transforming provider engagement at San Juan Regional Medical Center

The transformation in provider engagement and alignment for the medical staff at San Juan Regional Medical Center stands as a testament to the dedication and intentional efforts of both our leadership and clinical teams. In 2025, provider engagement moved from the 18th percentile nationally in 2022 to the 34th percentile, while alignment steadily rose from the 15th percentile to the 36th during that same timeframe. On top of these improvements, employees’ survey participation (i.e., the number of voices heard) is also on the rise.

This change has not been incidental. It is the result of strategic decision-making—listening to our providers through the Press Ganey provider engagement survey and acting with intention to address the challenges it surfaces.

In 2022, the lingering impact of COVID-19 continued to strain our organization and providers, as we cared for countless critically ill patients—many of whom (unfortunately) passed away. This created an environment where burnout, uncertainty, and emotional exhaustion deeply disrupted alignment and engagement. On top of everything, the organization underwent significant changes in its senior leadership: Tenured members of the team departed, and new individuals assumed key roles. We knew that rebuilding trust among our providers was essential for our providers to thrive. Our senior leadership team came together and brought in fresh perspectives to help stabilize and strengthen the organization, as well as create a robust framework to support them moving forward.

The first key milestone in this journey was improving the response rate to the Press Ganey survey. In 2023, only 71 providers—or 43%—completed the engagement survey. That’s not great turnout, and not ideal for making data-driven decisions. We knew that higher participation would give us a more accurate picture of our providers’ perspectives—and that meaningful change starts with listening to more voices.

Ahead of the 2025 survey, we launched an active campaign to encourage provider feedback. We started with broad messaging about the upcoming survey and the importance of completing it. Then we layered in targeted outreach from the Medical Staff Services office and clinic managers. To boost engagement, we even shared participation rates by specialty—sparking a little friendly competition between the various groups. As a result, the response rate skyrocketed to 77%, with 155 providers completing the survey—giving us more reliable data and indicating that providers felt more engaged and confident in sharing feedback.

Another step we took was to implement a formal leadership structure specifically designed for our physicians. We established a formal structure that empowers providers well beyond survey feedback. We defined leadership roles within the medical staff and developed “Directors” within our employed provider multidisciplinary group, San Juan Health Partners. Now, physicians have a seat at the table and a platform to actively engage in high-level decision-making, build accountability, and align more closely with larger organizational goals. Since its inception in 2022, this effort has matured and is now part of our organizational culture.

Recognizing that leadership skills are critical in driving alignment, the third step we took was investing in leadership training for our physicians—focusing on communication, collaboration, and influence. By building these capabilities within the medical staff, we’ve strengthened a culture of respect, cohesion, and shared goals—all critical for improving alignment across teams.

As we reflect on our positive three-year trend, it’s clear that our efforts have had a direct impact on provider engagement and alignment—which is reflected in our scores. These changes are not about numbers, but they’re demonstrative of an actual cultural shift within the organization. Providers feel more aligned with leadership, better supported, and more confident in their role within the organization.

We are immensely proud of the progress made. But the journey doesn’t end here. We are building on this momentum through:

• Ongoing leadership development: We continue to invest in leadership training and development for our physicians, ensuring they have the tools to lead effectively in an ever-changing healthcare landscape.
• Enhancing communication: We’ll maintain open lines of communication between leadership and providers, regularly soliciting feedback to address emerging challenges and concerns.
• Driving improvement through data: With higher survey participation, we now have a more reliable and accurate understanding of provider sentiment. We’ll continue to use this data to refine our approach and make targeted improvements where necessary.

Our improvement journey has been immensely rewarding. It’s proof that, with intentional leadership, consistent effort, and a commitment to listening to our providers, we can drive meaningful change. Our story highlights several important lessons for other healthcare organizations looking to improve provider alignment:

• Empower providers: Create opportunities to take on leadership roles. 
  Invest in leadership development: Equip providers with the necessary tools to thrive both clinically and as leaders.
• Encourage engagement: Actively encourage provider participation in surveys and other feedback mechanisms to improve engagement and identify areas for improvement.

And this is just the beginning of our journey. We’re excited to build on these successes and reach even greater heights in provider engagement and alignment in the years to come.

Take the next steps with Press Ganey

At Press Ganey, we’re proud to partner with organizations like SJRMC—and remain committed to fueling their continued progress. To learn more about our provider engagement survey, reach out to our strategic consultants, and we’ll be in touch.