A 'natural succession' to CEO: The evolving role of the chief quality officer

Twenty years ago, chief quality officers weren't a core part of a hospital's C-suite team. But today, it's hard to imagine how an executive team could function without one, especially in a healthcare landscape where reimbursement is increasingly tied to patient outcomes and other quality measures. 

Since 2017, WittKieffer has seen a fivefold increase in healthcare organizations seeking CQOs, the executive search firm said in a March blog post. This spike in demand comes as hospitals look to reinvigorate infection control and patient safety efforts after COVID-19-related setbacks

"Great quality leaders are the heroes of healthcare. They keep their eyes on the prize, which is the well-being of the patient. They monitor outcomes and they monitor input carefully and they hold everyone accountable for achieving the very best they can," Leah Binder, president and CEO of The Leapfrog Group, told Becker's. "It's a profession that's coming into its own with a whole new generation of people really using big data to drive change." 

Over the years, the role of the hospital CQO has grown to encompass much more than clinical compliance. Becker's recently spoke to two CQOs and three patient safety leaders to learn more about how the role has evolved and primary responsibilities today. 

What the role entails 

Whether called a CQO, a vice president of quality or something else, most hospitals have a core leader — most of whom are physicians or nurses — overseeing quality and safety. A decade ago, VP level quality roles started to become more common, and before that, the predominant roles in quality were coordinator, manager and director levels, according to Stephanie Mercado, CEO of the National Association of Healthcare Quality. 

"This made sense, because at the time, the function of quality was largely compliance related," she said. "Today, quality is seen as a strategy to advance safety goals, publicly reported measures, improve reimbursement and reduce and avoid costs, thereby improving the bottom line for health systems." 

This speaks to the experience of Matthew McCambridge, MD, senior vice president and chief quality, patient safety and acute care continuum officer at Allentown, Pa.-based Lehigh Valley Health Network. He's been in the CQO role for about six years. At a time when so much of the focus in healthcare is on the bottom line, he describes his role as this: 

"My job is to kind of negotiate and find that spot in the middle where we are taking crazy good care of patients and we're also [being] fiscally responsible," Dr. McCambridge said. 

In addition to leading quality, safety and infection control, much of his role is focused on value-based care. But that wasn't always the case. Before he became the full-time CQO, he served as LVHN's assistant CQO. At that time, his responsibilities mainly focused around hospital rankings. 

Now, he oversees much more. When a problem arises that doesn't fall directly into another area such as nursing, it often comes up through CQOs — an "all other duties as assigned bucket," as Dr. McCambridge put it. 

"And it can be just about anything," from a finance-related issue to clinical processes, he said. 

Like Dr. McCambridge, Leslie Jurecko, MD, describes her scope of work today as "wide" and "broad." She is the chief safety, quality and patient experience officer at Cleveland Clinic and also works closely with the Institute for Healthcare Improvement, teaching a course training up-and-coming CQOs. 

In a recent conversation with IHI's president and CEO, Kedar Mate, MD, Dr. Jurecko said they discussed how CQOs' involvement in process improvement and operations is often understated, and how some quality leaders see the role as the "natural succession plan of a CEO role." 

"Because you know the core competencies of quality, safety, patient experience, and you delve into all of the operational improvements. And our core key component of improvement is around nursing — because 70 percent of our staff are nurses," Dr. Jurecko said. 

Understanding improvement science and improvement tools is a critical skill for CQOs. "What we have to do is not only be influencers of culture and change management, but we have to know improvement tools; what tools to use for what problem we're trying to solve," she said. 

In an ideal scenario, CQOs have oversight of the six dimensions in the Institute of Medicine's quality framework: safe, effective, efficient, equitable, timely and patient-centered, said Tejal Gandhi, MD, chief safety and transformation officer at Press Ganey and former director of quality and safety at Boston-based Brigham and Women's Hospital.

"These things are very interconnected," Dr. Gandhi said, which speaks to why the scope of work might seem broad on the surface. 

The reporting structure 

This looks a bit different depending on the size of the organization, but generally speaking, CQOs are closely aligned with chief nursing officers, chief medical officers and CEOs.   

Large health systems might have a CQO leading system-wide efforts, with VP levels at the hospital level. Dr. McCambridge reports to the chief clinical officer at LVHN, who then reports to the CEO. He has around nine direct reports, including the administrator for quality and administrator for regulatory and accreditation, which together oversee more than 150 people. 

At Cleveland Clinic, Dr. Jurecko reports to the chief transformation officer who reports up to the CEO. 

Some CQOs do report directly to the CEO, but whatever the structure, a direct line of sight to the CEO is critical. 

"I'm a quality and safety leader who thinks that this is the most critical thing an organization does, so I think a CEO should have a really good line of sight to it," Dr. Gandhi said. She has had colleagues who have declined CQO roles because they didn't report directly to the CEO. 

"We do see a lot of variation," she said. "That being said, I think it could be successful in other models," so long as the CEO is engaged in quality and safety.

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