The Exec: 'All Providers Need to Reinvent Themselves in Some Way'

The chief medical officer of Allegheny Health Network shares predictions for 2023.

This year, financial pressures on health systems, hospitals, and physician practices will spur innovation, according to the chief medical officer of Allegheny Health Network (AHN).

Donald Whiting, MD, is CMO of AHN; president of the health system's physician organization, Allegheny Clinic; and chair of the AHN Neuroscience Institute. HealthLeaders recently talked with him about a range of issues, including predictions for clinical care in 2023, the challenges of being the top clinical leader at AHN, and physician engagement.

The following transcript of that conversation has been edited for clarity and brevity.

HealthLeaders: What are your predictions for clinical care in 2023?

Donald Whiting: The financial troubles of 2022 made all providers decide what they needed to do to realign their footprints and realign how they work because the cost of doing business was not going to go down anytime soon with inflation. So, this year, all providers need to reinvent themselves in some way, whether it is consolidating the footprint, going more to virtual care than bricks-and-mortar offices, or changing the services they offer. I also expect a surge in consolidation of providers.

HL: What are the primary challenges of serving as CMO of AHN?

Whiting: The chief medical officer of any organization is the clinical voice of that institution. Over the past several years, there have been many challenges—there's been COVID, the weak finances of providers, and inflation. Helping to bring a clinical sensibility to the issues in healthcare has been a challenge. You need to get all of the providers to understand the issues and be part of the solution.

At AHN, I am concerned about common issues related to quality of care and maintaining access. But for us in particular, we are also part of a large payer, so I look at opportunities to evolve healthcare from taking care of sick people to figuring out how we can keep them healthier. That creates opportunities for us to look at things in a different way than many healthcare providers.

HL: What are some of those opportunities?

Whiting: With us, because we are a provider with a large payer in the same area, we can look at sites of service changes, where we can do better care that is more efficient for the patient. That is not necessarily something that a provider alone would do.

We look at longitudinal care of a patient over time. So, if we can keep patients healthier, then that creates cost savings overall in the healthcare system. We also are focused on providing value-based care.

Donald Whiting, MD, chief medical officer of Allegheny Health Network. Photo courtesy of Allegheny Health Network.

HL: You are also president of AHN's physician organization, Allegheny Clinic. What are the challenges of leading a large physician organization?

Whiting: First of all, managing any physician organization revolves around having standards—standards of behavior, standards of care, and standards of practice. So, maintaining the standards is part of the job, but there is also recruiting good talent and being part of the medical staff development and growth of the provider organization.

HL: What are the primary elements of physician engagement?

Whiting: Physician engagement comes from physicians believing in the mission of your organization. You need to have transparency about the organization's plans and physicians' roles in those plans. Physicians need to understand how they fit into the organization and what their contributions can be. Then, you need to appreciate physicians for what they do.

HL: How do you make sure physicians feel appreciated?

Whiting: We have a couple of ways of doing that. We have core values for the organization, and we conduct core values surveys. Those surveys ask physicians whether they feel appreciated by the people they work with, whether they have friends at work, and whether they get frequent updates on how they are doing. We act on the results of those surveys.

We also have wellness surveys and a robust set of workstreams around improving wellness and feeling appreciated at work.

HL: You are also chair of the AHN Neuroscience Institute. How do you balance your responsibilities as CMO, president of Allegheny Clinic, and chair of the institute?

Whiting: The short answer is I have a strong team that I work with in each of those areas. They help me balance my responsibilities. There is a lot of overlap in each of those roles. For example, being chair of the Neuroscience Institute gives me more on-the-ground information than if I was just the leader of the physician organization—I can give much more direct input on how things are going by being involved in the institute. In the chief medical officer role, it also gives me input and insight into what is going on at the hospital floor level and  in the operating rooms. So, my roles are complementary in terms of sources of information.

HL: Are there any commonalities in these teams? How are you being supported?

Whiting: There are commonalities. In the institute, I have a dyad partner who is a service line vice president. As head of the physician organization, all of the service line vice presidents report to me, so I have ground-level information about what the service line vice presidents are dealing with, including trials and tribulations that I can help address. As CMO, I work with the president and the chief operating officer of the entire organization—between me as the CMO and the COO, we are in a dyad relationship that oversees the entire structure of clinical operations.

HL: What are your primary clinical challenges now that the crisis phase of the coronavirus pandemic has passed?

Whiting: Staffing is a big challenge. The people that left during the Great Resignation are not coming back. In our area, hospitals and ambulatory settings are not fully staffed, but the patient volume is coming back. The worry is that if we do not get relief for the people who are doing the work, more people are going to get burned out.

We are doing things to address workforce shortages. For example, on the nursing floors, we are piloting a half virtual, half in-person model, where somebody is at home doing part of the work and somebody is on the floor doing the hands-on work. This creates a pool of people you normally would not have been able to recruit, such as nurses who retired early but have good skill sets.

HL: What kinds of workforce shortages are you experiencing at AHN?

Whiting: It is across the board—we could use more of everything. We need CT techs, nurse's aides, medical assistants, nurses, and pharmacy techs. We need people in almost every area.

HL: What are the primary efforts you have in place to address workforce shortages?

Whiting: We are going upstream—we are working with high schools, community colleges, and trade schools. We are trying to get to people earlier. We are doing exploration visits such as bringing in high school and college students to shadow staff members to see what our jobs are like. We are providing scholarships to students if they commit to us when they are done with their studies. We are providing flexibility in our nursing schedules—someone can work just on weekends if they want that schedule, or work just four hours or eight hours if they are working somewhere else.

We are also working on retention. There has been lot of base salary increases to retain the people we have. There have been retention bonuses in certain areas. We try to care for employees as if they were family—we want them to feel as though they are cared for. We want to be a place where people want to work because we are a place that cares about their people.

Related: The Exec: Chief Clinical Officer Makes Predictions for 2023