The Exec: Memorial Healthcare System CMO Focused on Nursing Shortage

With a shortage of nurses, Memorial is relying on traveling nurses, which is placing a financial strain on the health system.

Nursing shortages are having a significant impact on Memorial Healthcare System, according to Marc Napp, MD, MS, executive vice president and chief medical officer of the health system.

Napp has served as Memorial's CMO since March 2021, succeeding Stanley Marks, MD, who retired in late 2020. He previously served as deputy chief medical officer at Mount Sinai Health System in New York. Before working at Mount Sinai, he served in medical leadership roles at Northwell Health in New York.

HealthLeaders recently discussed a range of issues with Napp, including workforce shortages, physician burnout, and clinical care predictions for 2023. The following transcript of that conversation has been edited for clarity and brevity.

HealthLeaders: What are the primary challenges of serving as the CMO of Memorial?

Marc Napp: The biggest challenge is the workforce—primarily nursing. We have had to bring in many nursing travelers from outside the organization, which can dilute the culture. When you bring in people from the outside, it is difficult to inculcate them overnight. There is also concern about the stability of the workforce because people are coming and going.

Another challenge is getting back on our feet after going through the coronavirus pandemic and the financial impact that the pandemic has had on us. With an itinerate workforce and the premium price that it costs, it puts a lot of our capital investments at risk because there is only so much money in the budget. We are spending a premium on our labor. While our hospitals are full and our emergency departments and operating rooms are busy, the cost to deliver care is significant and it is making it difficult to operationalize some of our plans.

HL: How are you rising to these challenges?

Napp: Fortunately, we have a very substantial bank account, so we can weather the storm—at least for the short-term and the medium-term. But we do not want to use our reserves for operations, and the portfolio took a hit when the market took a hit. Right now, we are managing our challenges because we have money in the bank. However, at some point, we are going to have to make some hard decisions. We are working on cost containment. We are cutting back on the premium labor, and we are growing certain programs that we had planned on growing before the pandemic hit.

If you were to look at us from the outside, you would not necessarily notice that there is any issue, unlike some of the other organizations across the country that are reporting massive losses. We are having losses, but they are not massive. So, we can hold our own for now.

Marc Napp, MD, MS, executive vice president and chief medical officer of Memorial Healthcare System. Photo courtesy of Memorial Healthcare System.

HL: What is the status of physician burnout at Memorial?

Napp: I must give the care providers at Memorial some credit. Their fortitude and their resilience have been impressive. We have lost few physicians to retirement or career changes as a result of the pandemic or burnout. There has been an impact on morale and work ethic to a degree as it is affecting every health system, but I have been impressed with the resilience of this group. We are concerned about wellness and burnout. But as far as burnout goes, I am aware of it and we are addressing it, but it has not been demonstrated to be a major concern for us at this point.

HL: How is the health system coping with physician burnout?

Napp: One thing I have noticed about Memorial compared to other organizations is that this is a place where people really love to work. We do a physician engagement survey every two years and we are going to start doing it annually. We are top decile in the country in terms of physician engagement. People like to work here. They are proud of working here. They feel supported, and like the organization cares about them, and that goes a long way in dealing with a lot of the burnout issues that other organizations are seeing.

In general, we have very little physician turnover, which is one measure of burnout. Part of that is the respect that the staff has for physicians and the mutual respect that physicians have for the staff. It is a collegial environment. There is tremendous rapport between the nursing staff and the physician staff. When you go to a small-town community hospital, it feels intimate, warm, and inviting. Despite the fact that we are a six-hospital system, you get the same feeling when you are in our facilities. That goes a long way to addressing the burnout issues that you see at other health systems.

Another thing that is important is there is respect for physician leadership at Memorial. We do a lot to support our medical staff leaders. The medical executive committee at this organization feels like they do something. At every other place I have been, the MEC wonders why it even bothers meeting. At Memorial, the MEC has a significant role to play. The medical staff officers are actively involved in what goes on in the hospitals. I am grateful to them because I have a great set of physician officers.

HL: Do you have predictions for clinical care in 2023?

Napp: We are going to see a rapid return to the way we used to do business before the pandemic. We are going to see some decline of telehealth, although there will be places where telehealth continues to make sense.

There will also be some significant innovation because we learned that we could innovate during the pandemic—we had to solve problems on the fly and remote patient monitoring is an example of that innovation.

We are going to see more of the same issues that plagued us before the pandemic in terms of difficulty discharging patients because of lack of placement opportunities in the community, complexity of the payment system, and issues of people not being able to access care. We haven't fixed many of the issues that existed before the pandemic—they just became less important in the scheme of things over the past two-and-a-half years. So, these issues are all going to resurface, and I am concerned about people feeling frustrated by these issues because we had some workarounds during the pandemic that made life easier that are not going to be there in the future.

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

Napp: What has happened in our area is clinical, but it is also operational and business-related. The certificate-of-need mandates were lifted in Florida, and we are a safety net health system surrounded by for-profit and aggressive not-for-profit health systems that are not safety nets. So, we take care of everybody whether they have an ability to pay or not. We have programs in place specifically for people who do not have insurance. We are taking care of those people, but that comes off our operations budget.

What is happening with the lifting of the certificate-of-need requirements is more competition, which is generally a good thing because it drives better performance, but it is not fair when the playing field is not level. I am concerned about skimming of patients—other health systems are getting the well-paying patients and we are being left holding the bag for the uninsured or poorly insured patients.

HL: How would you describe your leadership style?

Napp: I am collaborative. I feel strongly that I need to promote people to be experts in their areas and to recognize their expertise. So, I don't tend to be dictatorial or directive. That can lead to slower decision-making, but I do find that in the long run it has been the most successful way for me to lead. I am most comfortable in that mode.

The only time I lead in a different way is when we have a crisis situation such as an emergency management role. In that case, I become more directive. But even then, there is always going to be a cabinet of people I listen to. I am fortunate—I have some great leaders that I work with who have tremendous expertise, and I rely on them for counsel and to figure out what is best for the organization.

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