Peter Charvat shares his perspectives as chief clinical officer of the Bon Secours Richmond market.
Emergency medicine provides a solid foundation for serving in physician leadership roles, says Peter Charvat, MD, MBA, chief clinical officer of the Bon Secours Richmond market.
Bon Secours is part of Bon Secours Mercy Health. The Bon Secours Richmond market features seven hospitals.
Charvat's previous position was chief medical officer and vice president at St. Joseph's Main Hospital and St. Joseph's Children's Hospital in Tampa, Florida. Prior to working at St. Joseph's, he was chief medical officer and vice president at Johnston Health in Smithfield, North Carolina. He also served as a physician and Department of Emergency Medicine chair at St. Cloud Hospital in Minnesota.
HealthLeaders recently talked with Charvat about a range of issues, including clinical care predictions for 2023, the primary elements of physician engagement, and the keys to success in physician leadership. The following transcript of that conversation has been edited for clarity and brevity.
HealthLeaders: You have a clinical background in emergency medicine. How has this clinical background helped you serve as a physician leader?
Peter Charvat: First is the experience of working with a diverse group of clinicians and secondly working as a team. Emergency medicine is one of the specialties where you connect with physicians across the spectrum such as hospitalists, pediatricians, obstetricians, and surgeons. That has helped me because in my current role I work with physicians across all medical specialties.
The team-based care model has been just as important in serving as a physician leader. Emergency departments are definitely a place where you have a tightknit team—physicians, nurses, technicians, registration staff, and social workers. There is a full spectrum of frontline team members. We depend on each other and constantly work together. That gave me an appreciation for the skill sets that everybody on the team brings. In emergency medicine, the team makes the physician stronger, and the physician adds to the skill set of others.
HL: How do you rise to the challenge of clinical leadership in a broad and diverse market?
Charvat: First, a lot of my job is engaging, leading, and supporting teams. We have teams at the hospitals, at our service lines, and at our medical group. I try to find out the barriers they are having and how to support their work.
Second, in my role, there is a lot coming at me, and it would be easy to get reactive. I could spend my whole day just responding to what is coming at me. Instead, I do all I can to set aside about 25% of my time to be more proactive and forward-thinking. That's how I help keep the organization moving forward. A lot of that is creating vision—where are we now and how do we build on the success that we have had at Bon Secours Richmond?
HL: You are serving as a regional chief clinical officer. How do you balance overseeing clinical care at multiple facilities?
Charvat: Part of it is connecting with the staff. I make it a point to do rounding every week at our practices and hospitals, which helps me get to know people. That helps me identify the challenges at each of our sites of care and how I can help work through barriers. At lot of this role cannot be done in an office—you must get out and connect with people. I must appreciate the differences at the different sites of care and the market, and I must find ways to support those teams.
Peter Charvat, MD, MBA, chief clinical officer of the Bon Secours Richmond market. Photo courtesy of Bon Secours Mercy Health.
HL: Do you have any clinical care predictions for 2023?
Charvat: We will probably hear a lot more about long COVID and the chronic after-effects of acute COVID infections. We are learning that COVID has two phases: the acute phase, where we have gotten better at diagnosis and treatment, and the after-effect phase after infection, which affects multiple organs and can have multiple effects. We are challenged with how we diagnose long COVID, and we have few treatment options. This year, we are going to be increasingly focused on the long COVID syndrome, trying to come to a common understanding of what long COVID means, and supporting patients through their journey with long COVID.
In addition, toward the end of 2022 we saw a rise in non-COVID respiratory infections. We probably took our eye off the ball a little bit for influenza and RSV, and we saw them come on strongly at the end of last year. In 2023, we need to remain diligent—in addition to COVID, there are many other respiratory illnesses that we need to be aware of. We need to push for immunizations and preventive care.
HL: What are the primary elements of physician engagement?
Charvat: To sum it up in three words, it's credentials, objectivity, and similarity.
If you are going to engage and work closely with physicians, as a leader you must have credentials. We need to bring something to the table, whether it is administrative expertise or an understanding of what physicians need in their practice. We must bring value to the conversation with physicians.
In terms of objectivity, when we engage physicians, we must be open-minded and objective. We may not always be on the same page or see things exactly the same, but as leaders we need to be objective, to put ourselves in physicians' frame of reference, and to understand the challenges they are facing in clinical practice.
For similarity, we may have some differences, but we need to focus on what we agree upon such as high-quality patient care, safety absolutes, and putting the patient first. From there, how can we engage and have conversations about how we support physician practice and how physicians can support patients and the organization?
HL: What are the keys to success for physician leadership?
Charvat: One thing is to diversify your skill set. When I transitioned from clinical practice to an administrative role, I realized that I had a lot of gaps in nonclinical skills such as finance and human resources. We are constant students in medicine—there is research to follow, new techniques, new therapies, and diagnostic options available. In the clinical world, physicians are constantly learning, and when you take on administrative roles learning must continue.
Physician leaders also need to see the perspectives of those they work with and be part of a team. In medicine, you are working closely with clinical teams such as other physicians and nurses. When you get into leadership roles, you are spending time with non-clinician leaders. You need to be aware of everybody's perspectives and the unique skills they bring to the table. You need to complement each other and emerge stronger as a team.
HL: Now that the crisis phase of the coronavirus pandemic has passed, what are the primary clinical challenges at Bon Secours Mercy Health?
Charvat: Two things that come top of mind are clinical workforce and more complex patients.
Early in the pandemic, we saw a lot of frontline healthcare workers leaving the workforce or moving to different positions, s there were shortages, which we saw a lot in nursing. Fortunately, we have been able to develop some programs to respond to this challenge, and we have done a good job at attracting and retaining talent.
The other thing is that, overall, patients are becoming more medically complex. There is a lot more chronic illness, and we need to continue to prepare to provide higher levels of service to patients in our hospitals. There is a shift of care from the inpatient to the outpatient setting, but at the same time, the patients who are in the hospitals are very complex, with comorbidities and chronic conditions. Fortunately, we have a lot of diagnostic and treatment options. We need to position ourselves with education, training, technology, and resources to manage this increasingly complex patient population.
HL: What are the primary efforts you have in place to address workforce shortages?
Charvat: We are looking at educational opportunities for our associates—giving them opportunities for new degrees and training. We are giving associates opportunities for mobility within the organization. Fortunately, we are very broad and diverse, so we have a variety of opportunities within our markets. We are also providing appropriate work-life balance for the well-being needs of our associates.
For the physician workforce, we are focusing on physician well-being. We are trying to support the health of our practitioners. We also have many opportunities for physicians in our organization—different hospitals, different practices, inpatient settings, and outpatient settings. We can offer a range of work experiences that can draw physicians to our markets.
HL: Why is patient medical complexity increasing?
Charvat: One factor is we have become better at managing disease, so we are able to care for patients longer and longer through their diseases. We can manage chronic illnesses. If you look at the new technologies and therapies that we have compared to where we were 20 years ago, we have a lot more treatment options available.
There are also demographics. The population is getting older, and naturally they are going to have more illnesses and chronic disease. We are going to see more and more patients with a multitude of chronic illnesses that need management.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
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As U.S. healthcare emerges from the coronavirus pandemic, managing increasingly complex patients is going to be a major challenge.