Leading Through Unprecedented Change: 6 Behaviors CMOs Must Master

Hospitals and health systems across the country are currently experiencing unprecedented cost-control pressure, which is leading to significant changes in the healthcare delivery system. Pay-for-performance, reimbursement pressure, consolidation and collaboration present both opportunities and challenges, and success in the future is expected to rely on close alignment and integration with physicians — a finicky bunch. As such, the role of the chief medical officer will rise in prominence, and the scope and role of the CMO will expand.

"The historical role of a vice president of medical affairs, who deals with quality improvement, utilization management and medical staff issues is now expanded considerably to be more strategic and involving more senior management skills than the position ever required previously," says Steven Berkowitz, MD, founder of SMB Health Consulting, who served for 13 years as CMO for St. David's Healthcare, an eight-hospital system based in Austin, Texas.

The expanded role of a CMO necessitates an expanded skill set, explains Dr. Berkowitz. "Not only do you need good clinical skills, but you also need good operational and strategic skills," he says. The specialized skill set now required of CMOs is not unlike the specialized skill set required of physicians in very specialized areas of medicine. "Physicians who choose management enter a specialty in and of itself," he says. "It requires special knowledge, special skill sets and has its own literature."

1. Embrace the role of 'Chief Relationship Officer.' One of the long-standing responsibilities of a CMO is serving as a liaison between hospital administration and medical staff. This physician alignment function has become more challenging in recent years as hospitals engage in more complex and sophisticated relationships with physicians, including employment, co-management and joint ventures. Yet, the number one skill that improves the likelihood of success in this area, according to the CMOs interviewed for this article, remains steadfast: communication.

"I think the most important skill set for a CMO is communication skills. Broadly, they need to be able to work with a diverse, interdisciplinary group within the hospital or health system and also be able to reach out beyond that and seek input from a variety of sources," says John Murphy, MD, CMO of Rhode Island Hospital in Providence. "They must make others feel respected and that their input is valued. CMOs must also be able to convey clear messages about what is happening and why, and how we're going to make changes."

Additionally, Dr. Murphy believes CMOs must ensure administrative leaders demonstrate their conviction for achieving quality and efficiency goals. "Your efforts to effectively enhance processes depend not only on an engaged group of employees and physicians but also on a clear statement from leadership that they're behind it."

Linda Efferen, MD, CMO of South Nassau Communities Hospital in Oceanside, N.Y., agrees CMOs must be skilled communicators. "You really have to be able to speak honestly and still sound hopeful," she says. "Be forthcoming, but don't presume you always know how to get there. Really look to your team and your front-line providers for their expertise to identify what needs to be done to meet the challenges."

2. Unwavering advocacy for patient safety and quality outcomes.
CMOs must remain staunch advocates for patient safety and quality, even as their roles expand to other responsibilities, says Dr. Berkowitz. Overseeing clinical care pathways and other improvements in preparation of value-based payments are part of this, but so are the more traditional roles of investigating quality concerns and ensuring changes are made to prevent errors. Additionally, the CMO must become a visible advocate for patient safety, ensuring other physicians, staff and the community understand the organization's commitment to quality.

Dr. Murphy became a well-recognized figure at Rhode Island Hospital after he appeared in posters throughout the hospital used to raise awareness of hand washing. "Every single physician, staff member, patient and family saw a picture of me washing my hands. I even overheard children say to their parents, 'That's the guy in the poster,'" he says. His hospital also works with GE Healthcare Performance Solutions and participates in GE Healthcare's national patient safety organization to acquire and interpret data that can be used to inform other improvement efforts.

3. Oversee clinical quality improvement. Another important role of the CEO is to oversee quality improvement programs, including clinical care process improvement and standardization. As reimbursement moves toward pay-for-performance, removing variation in clinical care, while still allowing for personalized medicine, is crucial, because standardization reduces costs and improves quality.

"Implementing best practices in all service lines where best practices are available is one of the top things the CMO needs to lead," says Dr. Berkowitz. This doesn't necessarily mean the CMO must participate in every meeting for every service line's development of clinical processes of care, but he or she must ensure they stay on track and provide guidance while they develop these evidence-based models.

According to Joseph Salipante, MD, CMO of Unity Health System in Rochester, N.Y., this can also mean holding others accountable. "Make members of the team accountable for the results of the initiative," he says.

Dr. Murphy concurs. "You have to hold people accountable for complying to the well-vetted consensus on where they're headed," he says.  

4. Embrace transparency. Key to achieving quality improvements is a meaningful set of measurements from which to assess performance and track improvements.

Dr. Berkowitz believes successful CMOs must "embrace data transparency as a performance improvement tool. It's really more than a tool; it's actually a whole process."

However, if physicians question the validity of measures and benchmarking data, then any efforts to improve quality and efficiency will be futile. Therefore, all data that is measured and reported to physicians and clinicians should be either selected by or at least approved by the clinicians themselves. After measures are selected, they must be tracked and routinely reported, at least on a quarterly basis. Examples of measures might include average length of stay and charges for a certain diagnosis related group (DRG). The reports should include performance against the selected measures by service line or DRG and by clinician and must be presented in an easy-to-understand manner.

5. Understand information and manage data. Related to encouraging transparency, CMOs must also be able to interpret data appropriately and use it to inform decisions about clinical care processes and other areas. In today's healthcare environment, this often requires some level of comfort with health information technology.

"Another big area facing everyone in my position is how to effectively use health information technology effectively. How do you use technology to connect those within hospital and everything outside, such as physician offices, home health and extended care facilities?" says Joel Reich, MD, who serves as CMO for Eastern Connecticut Health Network, based in Manchester, Conn. ECHN is currently working to extract data from these various systems and use it to inform processes to reduce readmissions and prepare for bundled payments. The system is also working to develop a private health information exchange to share data with non-hospital providers — a project in which Dr. Reich is closely involved.

Further suggesting the importance of a CMO's IT acumen, the American College of Physician Executives now offers a Health IT Leadership Certificate Program for physician executives. And, last September, the American Board of Medical Specialties approved clinical informatics as a formal subspecialty certification, sponsored by the American Board of Preventive Medicine. The ABPM agreed to sponsor the new subspecialty examination, which was initially developed by the American Medical Informatics Association, with support from the Robert Wood Johnson Foundation,

6. Guide the organization to excel in the pay-for-performance process. Finally, one of the most important responsibilities of a CMO under future healthcare delivery models will be the ability to guide the organization to success under pay-for-performance models, including value-based, bundled and capitated reimbursement, says Dr. Berkowitz.

While this may seem a daunting task, the ground work for pay-for-performance success involves many of the functions previously mentioned, including overseeing quality improvement projects, gaining consensus for measures, tracking performance and encouraging transparency, using health information technology to inform decision making, and coordinating care with clinicians outside the hospital's walls.

CMOs may additionally find themselves involved in helping to determine the level of risk a system can take on and how payments will be divided among the hospital and other providers — a task that will no doubt involve serious listening and consensus building.

"The old joke used to be that a CMO was a man without a country," says Dr. Reich. "Today, it's more like a man with too many countries."

Related Articles on Chief Medical Officers:

Paul Haut Named New Riley Hospital CMO
Dr. John Riccio Named CMO of Auburn Memorial Hospital in New York

John Dingilian Named CMO of Simi Valley Hospital in California

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