Building the Best Physician Team

The physician teams have led to creation of CHS' Chest Pain Network, a network of nine area hospital and local EMS agencies that streamlines the transfer and treatment of heart attack patients. It also allows patients with less critical conditions to be appropriately cared for closer to home.

The system has also launched a Heart Success program, with a multidisciplinary team including an advanced care practitioner, patient navigator, dietitian, social worker, and pharmacist. This initiative has resulted in improved clinical outcomes, Colavita says. The program focuses on educating heart failure patients to better manage their disease and return to the care of their primary care physicians and cardiologists. The idea is to prevent readmissions and enhance the patients' quality of life.

Colavita credits this team concept to improvements in CHS' readmission rates. From the third quarter of 2011 to the first quarter of 2012, the 30-day readmission rates at CHS' Carolinas Medical Center decreased from 19.7% to 11.4%, according to the hospital.

Developing a council
Ronan saw an opportunity to do things differently by restructuring Western Maryland's physician team after his veteran CMO retired from the position and became a hospitalist at the facility. Ronan thought about the long list of challenges the system faced, even though it had just opened a new facility in late 2009.

Ronan knew that, in earlier years, the hospital would have replaced the CMO quickly to ensure continuity. But Ronan and his staff realized the landscape of healthcare was transforming so much that it was no time for a quick fix.

Following guidance from consultants, Ronan asked the president's six-member quality council to identify and bring on board six additional physicians to work directly with the C-suite. Besides participating in the search for a new CMO, the larger purpose was to help determine the direction of the hospital system.

These physicians were official and unofficial leaders. "This wasn't our medical executive committee; these were movers and shakers in the hospital. They included independent practitioners, as well as hospitalists," he says.

"Nothing at the hospital gets done that the medical staff doesn't agree with," Ronan says. "The medical staff feels very involved in the decision-making at the clinical level, but it's also important they feel involved in decision-making at the management level."

The 12 physicians on the president's council in turn led various subcommittees composed of three physicians each, focusing on an array of specific subjects: examining documentation and coding procedures; reducing readmissions and revamping the hospital's service lines; opening a new wound care center and considering a heart failure clinic; and improving programs to combat pneumonia. The hospital also relied on this subcommittee structure to look into ways to increase home healthcare, with the idea of reducing utilization. Another issue the subcommittee investigated involved evaluating community needs so patients would be less likely to seek hospital care in distant cities like Baltimore and Washington, D.C.