Los Angeles County (LAC) operates the second-largest municipal healthcare system in the country. With 750,000 patients and 23,000 employees, proper medical notation is vital to ensuring quality and continuity of care across this vast network. Unfortunately, current documentation practices are a driver of provider burnout, potentially result in poor patient care, and may contribute to bias against marginalized patients. The FUSE Executive Fellow will advance change management efforts to implement technological and behavioral improvements in how LAC healthcare providers write medical notes.

Fellowship Dates: April 22, 2024 – April 21, 2025

Salary: Executive Fellows are FUSE employees and receive an annual salary of $80,000. Fellows can also access various health, dental, and vision insurance benefits. Compensation for this year of public service is not intended to represent market-rate compensation for the experienced professionals in our program.


FUSE is a national nonprofit working to expand social and economic opportunities, particularly for communities that a history of systemic and institutionalized racism has limited. FUSE partners with local governments and communities to more effectively address pressing challenges by placing experienced professionals within city and county agencies. These FUSE Executive Fellows lead strategic projects designed to advance racial equity and accelerate systems change. Since 2012, FUSE has led over 250 projects in 40 governments across 20 states, impacting the lives of 25 million people.

When designing each fellowship project, FUSE works closely with government partners and local stakeholders to define a scope of work that will achieve substantive progress toward regional priorities. FUSE then conducts an individualized search for each project to ensure that the selected candidate has at least 15 years of professional experience, the required competencies for the role, and deep connections to the communities being served. They are data-driven and results-oriented and able to effectively manage complex projects by developing actionable roadmaps and monitoring progress to completion.

Executive Fellows are hired as FUSE employees and embedded in government agencies for at least one year of full-time work. Throughout their fellowships, they receive training, coaching, and professional support from FUSE to help achieve their project goals. FUSE Executive Fellows bring diverse perspectives and new approaches to their projects. They build strong relationships with diverse arrays of stakeholders, foster alignment within and across various layers of government, and build partnerships between governments and communities.


Los Angeles County’s Department of Health Services (DHS) operates the second-largest municipal health system in the country. With 26 health centers and four hospitals, they serve approximately 7.5% of County residents annually, including some of the most vulnerable patients (e.g., incarcerated individuals, residents experiencing homelessness, and undocumented patients). Burnout is a significant concern for DHS leadership as they manage nearly 23,000 staff. According to the American Medical Association, medical burnout is so bad that one in five doctors and 40% of nurses consider leaving their profession in the next two years.

One primary driver of fatigue is the electronic medical record (EMR) documentation burden. Medical record documentation ensures seamless, high-quality care between appointments and providers. However, the current EMR and documentation practices are unwieldy and create significant demands on providers’ time, accelerating the burnout crisis.

In addition, medical documentation can inject bias into healthcare. A recent study found that Black patients’ notes were more than twice as likely to use negative descriptions; another found that practitioners who read biased notes held negative opinions of their patients and were less aggressive in their prescribed treatment. Bias in notes can lead to disparities in patient outcomes and insurance billing, and if patients discover negative comments, they may be less likely to seek care in the future.

Los Angeles County DHS will partner with FUSE to transform provider documentation practices across the County’s health system. The FUSE Executive Fellow will help develop, launch, and lead a change management plan to help providers adopt a new note-taking approach that reduces time burdens and bias. In addition, the Executive Fellow will equip DHS with a methodology to measure success in this effort. As a result of this work, healthcare providers across DHS will have the documentation practices and templates they need to deliver better patient outcomes, reduce provider bias, and preserve their well-being.


The following provides a general overview of the proposed fellowship project. This project summary and the potential deliverables will be collaboratively revisited by the host agency, the fellow, and FUSE staff during the first few months of the fellowship.

Starting in April 2024, the FUSE Executive Fellow will build deep relationships with various critical stakeholders. This includes other county departments (e.g., Department of Health Services, Department of Mental Health), healthcare providers (including those working with incarcerated, unhoused, and undocumented patients), local health justice and equity leaders, and members of the public (with an emphasis on Black, Indigenous and People of Color communities (BIPOC)) to understand the strengths, needs, opportunities, and aspirations these partners have for medical records, provider and patient wellbeing, and healthcare equity. At the same time, the Executive Fellow will conduct an extensive desk review to identify best practices and innovative approaches to leveraging technology to improve medical documentation outcomes in large, diverse healthcare systems like Los Angeles County.

Next, the Executive Fellow will develop and launch a change management plan to adopt and scale new medical documentation technology and practices across the County’s health system. In order to launch this plan successfully, the Executive Fellow will conduct extensive stakeholder engagement with providers and leadership to ensure the plan is feasible. This engagement will be key to generating consensus for technology adoption and new approaches to writing notes.

Finally, the Executive Fellow will develop a methodology to measure the success of the change management plan. Success metrics should monitor outcomes for all stakeholders, including provider satisfaction, patient outcomes, insurance payments, and equity. In addition, the methodology should allow DHS leadership to easily compile and synthesize metrics into a logical, compelling narrative that enables continuous performance improvement as the notation system changes.

By April 2025, the Executive Fellow will have overseen the following:

  • Conduct a Stakeholder Listening Tour – Develop relationships with stakeholders within DHS, across healthcare providers and leaders, community groups, and members of the public (with an emphasis on BIPOC residents). Conduct a literature review of medical records management, technology, and healthcare equity in large, diverse health systems similar to LAC.
  • Develop & Launch Change Management Plan – Conduct extensive stakeholder engagement to develop and launch a feasible, equitable approach to scaling medical documentation technology and note-taking practices across the County’s health systems.
  • Design a Methodology to Measure Success – Identify success metrics across all areas of interest (e.g., satisfaction, patient outcomes, equity) and all stakeholders. Develop a system to compile metrics, report on results, and understand the implications for future change management efforts.


  • Executive Sponsor – Dr. Hal Yee, Chief Deputy Director of Clinical Affairs & Chief Medical Officer and Dr. Michael Owens, Director of Medical Affairs & Administrative Support; Department of Health Services
  • Project Supervisor – Dr. Chase Coffey, Chief Quality Officer; Los Angeles General Medical Center


In addition to the qualifications listed below, a background in communication and change management, with experience in local health systems is strongly preferred for this project.

  • Synthesizes complex information into clear and concise recommendations and action-oriented implementation plans.
  • Develops and effectively implements both strategic and operational project management plans.
  • Generates innovative, data-driven, and result-oriented solutions to difficult challenges.
  • Responds quickly to changing ideas, responsibilities, expectations, trends, strategies and other processes.
  • Communicates effectively both verbally and in writing, and excels in both active listening and conversing.
  • Fosters collaboration across multiple constituencies in order to support more effective decision making.
  • Establishes and maintains strong relationships with a diverse array of stakeholders, both inside and outside of government, and particularly including community-based relationships.
  • Embraces differing viewpoints and implements strategies to find common ground.
  • Demonstrates confidence and professional diplomacy, while effectively interacting with individuals at all levels of various organizations.

FUSE is an equal opportunity employer with core values of diversity, equity, and inclusion. We encourage candidates from all backgrounds to apply for this position.