The Exec: Rising to Recruitment, Financial, and Behavioral Health Challenges

At MaineGeneral Medical Center, clinical staff recruitment is boosted by an attractive organizational culture, an earnest approach to healthcare, and a state-of-the-art physical plant, the hospital's CMO says.

The CMO of MaineGeneral Medical Center says he has three primary challenges at the community hospital: clinician recruitment, financial sustainability, and mental health and addiction medicine resources.

Dana "Dan" Vick, MD, MBA, has been CMO of MaineGeneral Medical Center since 2022. MaineGeneral Medical Center, which is located in Augusta, Maine, is a 198-bed community hospital that is part of MaineGeneral Health. The hospital is considered a rural referral center, with Augusta a modestly sized city with only about 20,000 residents. His prior healthcare leadership experience includes serving as vice president of medical affairs for two Ascension health system hospitals: St. Vincent Evansville in Evansville, Indiana, and St. Vincent Warrick in Boonville, Indiana.

HealthLeaders recently talked with Vick about a range of issues, including how physicians are involved in administrative leadership at MaineGeneral Medical Center, patient safety at the hospital, and patient experience. The following transcript of that conversation has been edited for clarity and brevity.

HealthLeaders: What are the primary challenges of serving as CMO of MaineGeneral Medical Center?

Dana "Dan" Vick: There are three things that are challenging.

One is staff recruitment. We are constantly recruiting for various specialties. About 85% of our medical staff are employed, which puts the onus on us as an organization to recruit clinicians. Fortunately, one of the things that makes us attractive is we have a great organizational culture, which runs from the top down. We have a lot of longevity throughout our organization in many employment levels.

We are taking care of patients who are members of our community—sometimes they are family members and sometimes they are neighbors of people who work here. There is a sense of earnestness in how we approach healthcare, which helps with our recruitment. We also have an excellent physical plant—the hospital was built about 10 years ago with input from people who work throughout the organization. The hospital is a place that is convenient for patients and user-friendly for those who work here. When you step inside the hospital, it looks like it opened just last week. When we have recruits who come to the hospital, they are impressed by the facility.

The second challenge is financial. Like every healthcare organization, we are struggling with decreasing reimbursement while trying to figure out how to increase access for patients. We are trying to reduce length of stay to be a more financially adept organization, while providing the care that patients need in as timely a manner as possible.

The third challenge is mental health and addiction medicine resources. In Maine, we struggle to have enough resources to address the issues that occur in those realms. In many states, mental health and addiction medicine has become a crisis.

HL: How are you rising to the financial challenge?

Vick: We look at the ways we can improve upon the services that we offer to increase access and deliver those services in a cost-effective manner. We also try to limit length of stay for patients. Additionally, we try to make sure that we capture appropriately the services that we provide to boost reimbursement.

HL: How are you rising to the mental health and addiction medicine resources challenges?

Vick: We continue to recruit adult and pediatric behavioral health staff. We are also working with telehealth providers to help provide some of the care that we are not able to provide on-site.

HL: What is the physician compensation model at MaineGeneral Medical Center?

Vick: All physicians are on a base salary to guarantee them a base compensation. Most of the service lines can pay physicians additionally based on productivity. We used to have payment based on value, but we have folded that component into the base salaries because we found that we had to compete with other hospitals for recruitment, and that has made us more competitive.

Dana "Dan" Vick, MD, MBA, chief medical officer of MaineGeneral Medical Center. Photo courtesy of MaineGeneral Health.

HL: What is the approach to patient safety at MaineGeneral Medical Center?

Vick: We have a multipronged approach. We have a daily report prepared by risk management staff showing anything that may rise to the occasion of being a miss or a near miss. We have a peer review process with the medical staff that looks at cases that may rise to serious patient-safety criteria.

We also have a Speak Up Award—employees are encouraged to speak up if they see something that may have the potential to cause a problem. So, employees receive an award when they have found an issue and potentially avoided a patient safety event from happening. We also conduct rounds on staff and patients from the senior administrative director levels.

We try to promote a culture of safety. We have worked on flattening the hierarchy, so employees on the frontlines know they can bring their concerns forward quickly. We also have a process design department, and they do a lot of lean process work. We are doing everything we can to reduce errors and to improve patient safety.

HL: Is there a process in place when medical errors occur?

Vick: When a medical error occurs, we determine whether it represents a sentinel event or significant event. Then we implement our medical staff peer review process to look at the case.

HL: What are the keys to success in patient experience in the inpatient setting?

Vick: Two things that are important are teamwork and communication.

Healthcare is not an individual endeavor. It takes the work and input of everyone on the healthcare team. So, we have promoted teamwork and have built teamwork into our culture. We conduct interdisciplinary team rounding every day on our medical and surgical wards.

We also promote the value of communication. You can never communicate a message too frequently—that is very important. We want our patients to understand what is occurring with their healthcare. We want to hear from them if they have any concerns. So, we survey patients frequently.

HL: How are physicians involved in administrative leadership at MaineGeneral Medical Center?

Vick: They are involved in several manners. We have employed medical directors for our service lines. We have our medical executive committee, which consists of our department chairs. We have medical staff and hospital committees, where physicians serve in leadership roles. And we have medical staff members who are on the board of directors.

We have worked to build a leadership development program for our medical directors, assistant medical directors, and lead advanced practice providers. This consists of quarterly half-day retreats that we hold at an off-site facility. We cover several topics such as leading through a team-driven approach, how to overcome dysfunctions in a team, and understanding physician compensation. So far, this leadership development program has been well received, and it is helping us grow the next generation of leaders and helping current leaders grow in their roles.

HL: What are the benefits of having physicians involved in administrative leadership?

Vick: It helps because otherwise you can get engrained and focused on components of healthcare without understanding why we must do some of the things that we do in running a healthcare organization. When physicians have an opportunity to be involved in administrative leadership, it gives them a better sense of the other side of the equation beyond patient care, and it allows them to convey that message to their medical staff group or department.

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