Chief Medical Officers Discuss Adjusting to a Changing Focus
Over the past two decades, the role of Chief Medical Officer has evolved far beyond one of being a hospital-based, part-time position to one that is of considerable importance with responsibilities that include improving a hospital's performance metrics, ensuring the highest quality of care and reducing costs through an efficient use of resources, while forging an alliance between providers and the hospital administration.
This unwritten change in job description has come about largely because of a growing nationwide demand for quality, value-based healthcare. Hospital systems and physicians find it increasingly more difficult to function as separate entities. It is imperative for both groups to align their goals to provide safe and high-quality healthcare at a lower cost.
It's a tough job - the CMO essentially links all aspects of patient care - but, according to three Memphis-area CMOs, far from impossible. The key is to keep one simple rule in mind: Always put the patient first. The rule surfaced recently when the trio of CMOs had a roundtable discussion conducted by Pamela Haskins, publisher of Memphis Medical News.
Participants in the roundtable discussion were:
- Martin Croce, MD, CMO, Regional One Health
- Susan Nelson, MD, CMO, Church Health
- Henry Sullivant, MD, Vice President and CMO, Baptist Memorial Healthcare.
The group discussed a range of topics, including the importance of staying connected to patients and the challenges the CMOs face in their positions, such as the patient's perception of quality care and how important it is to bridge the divide between hospital administration and providers.
All three CMOs said they became physicians to show compassionate care to patients. Even though they've transitioned to a top administrative role, they affirm it's more important than ever to stay connected to the patient in order to make top-level decisions on patient care.
"Hospitals are obscured by so many layers that administration can forget the patients," said Dr. Croce, who transitioned from chief of trauma at Regional One Health to CMO last August. "You need physicians and nurses there to take care of them."
Dr. Nelson said she stays connected to patients by still practicing family medicine. Three-and-a-half days a week she treats patients at Church Health, a local faith-based nonprofit organization that provides primary and specialty healthcare to low-income and uninsured Shelby County residents.
"It's important for me to still see patients because it helps me remember why I'm sitting in a meeting," Dr. Nelson said. "I experience what it's like each day in patient care at Church Health. I have the best of both worlds, which directly impacts the patient. It helps keep me grounded. I continue to energize my passion in order to make the system work better."
As a result of her clinical efforts and experience, she said that she and her team have been able to cut down on wait times for low-income and uninsured patients to see a physician from four months to two weeks. Additionally, she saw the need for Church Health to offer urgent care for walk-in patients during certain hours. Church Health relies on a volunteer network of physicians and nurses to assist in primary care evening clinics and specialty clinics.
Similarly, Dr. Croce and Dr. Nelson both battled cancer as physicians. They said they bring a unique perspective to the executive table because they have experienced healthcare from both sides.
"I've had to maneuver through the system," Dr. Croce said. "I've seen what the process looks like from the provider and patient side, and I think that helps me see the advantages and disadvantages in my role."
Dr. Nelson said her experience as a patient helped her implement culture change.
"You realize small things matter," she said. "It can be as simple as telling providers and medical staff to wear a name tag and introduce themselves. I can't tell you how scary it is as a patient who is receiving treatment for cancer when the provider or staff doesn't tell me their name. Something as simple as that makes a big impact on the patient."
Dr. Sullivant, an OB/GYN who transitioned to CMO of a 22-hospital system at Baptist, said he still makes decisions with patients in mind every day, but instead of impacting 34 patients per day as he did in his medical practice, he can make a difference in the lives of thousands of patients.
"There's nothing like being at a patient's bedside and it's easy to become disconnected, but we can connect back to that purpose in a different way and affect more patients on a larger scale," Dr. Sullivant said.
Perception of Care
One of the challenges CMOs face nationwide is providing quality of care at a lower cost, but Dr. Sullivant said that CMOs must take that concept one step further. He said understanding a patient's perception of care is just as important. CMOs must be considerate to the community's needs and then offer up a strategy.
"Perception these days is reality," Dr. Sullivant said. "It's not enough to provide quality care; the patient must perceive the quality of care is the best. It's become a key factor, and leadership must be responsive. At Baptist, I meet jointly with each hospital CEO monthly to discuss each community's perception of the care it receives from our system."
Dr. Nelson agrees and said a patient's perceived access to care makes a big difference as well.
"It doesn't matter how smart you are or how good of a physician you are, if the patient isn't happy with the care or how to access it, that's what matters," Dr. Nelson said. "That's where we are now in healthcare."
Bridge the Silos
Another challenge CMOs are faced with is merging their organization's goals and each provider's goals, which can sometimes be different.
"We must develop a relationship with our provider community and foster them, so we can align strategic goals, " Dr. Sullivant said. "The center of the conversation is what's right for patient care."
Dr. Croce makes the effort to do this at Regional Medical Center.
"CMOs need to be seen walking the hallways in hospitals and visiting different departments," Dr. Croce said. "I visit the newborn center purposefully because it's a department that isn't my specialty. I didn't live in their world. I'm the voice for all physicians, and in order to be effective in what I'm doing, I must understand how someone else handles patient care."
Dr. Sullivant compares his job to a three-dimensional chess game where he has to lessen the gap between each department at the hospital, which he said can sometimes want to operate independently.
"I handle many issues at once, like financing, quality and nursing," Dr. Sullivant said. "All of these departments can live in silos, so it's my job to merge them and bridge the divide."
Seek Admin Roles
All three CMOs stress the need for physicians to seek more administrative roles in a hospital or clinical setting. They say the physician's goal to do what's best for the patient doesn't change even though he or she may no longer treat a patient directly.
"We need more physicians in administration roles," Dr. Croce said. "There aren't enough of us pursuing leadership roles in hospitals. Your No. 1 job is to make sure that patients have access to care no matter what. It's our job to take care of patients who can't take care of themselves."
Dr. Sullivant stresses that it's a good idea for physicians who are interested in becoming CMOs to enroll in a masters of healthcare management program or a similar training program that covers business administration, public health and hospital administration.
"This is the hardest job I've ever had, but it's also the most stimulating and fun," Dr. Sullivant said. "I feel like I'm still meeting the same call to affect patient's lives, but instead of a few at a time, it's thousands."
Keep It Simple
Despite the complexity of the CMO position, experts agree that in the final analysis it's the patient who matters most.
"I've learned that it's important to keep it simple," Dr. Croce said. "You must always put the patient first and if you do that, you can't go wrong."