The CMO of Robert Wood Johnson University Hospital Rahway found the way to support physicians in moving to team-based care when they did not see the need to change.
CMOs must help physicians shift their mindset of autonomy to partner with administrators to manage and deliver strong outcomes, says Carol Ash, DO, MBA, CMO of Robert Wood Johnson University Hospital Rahway. "CMOs must be role models, addressing the challenge by helping their physician colleagues move from a culture of autonomy to working as part of a successful team, with the patient as the first priority."
Ash has been CMO of RWJ University Hospital Rahway since June 2018. The hospital is part of RWJBarnabas Health. Her previous leadership experience includes serving as director of the ICU at Robert Wood Johnson University Hospital Hamilton.
HealthLeaders recently talked with Ash about a range of issues, including the challenges of serving as a CMO, becoming the first CMO of RWJ University Hospital Rahway, and the keys to success in case management. The following transcript of that conversation has been lightly edited for clarity and brevity.
HealthLeaders: What are the primary challenges of serving as CMO of RWJ University Hospital Rahway? How have you risen to these challenges?
Carol Ash: The way physicians do things has not changed much since 1919, when the American College of Surgeons (ACS) published the principles defining physician professionalism. These principles promoted physician self-governance and autonomy. More than two decades ago, the Institute of Medicine's two watershed reports, "To Err is Human" and "Crossing the Quality Chasm," showed us that the way we were doing things was not resulting in high-quality outcomes for patients. Change was needed. The Affordable Care Act and the advent of electronic healthcare records were meant to improve healthcare performance to reach new, high-quality goals. The CMO has played—and continues to play—a critical role in ensuring physicians can work with organizations to meet those goals and remain competitive.
The challenge is that despite recognizing the need to transform and put the needs of the patient and community first, our nation's medical community remains entrenched in the mindset of the ACS model of professionalism.
When I arrived at RWJ University Hospital Rahway, I knew what had to be done. I had to clearly communicate our new direction to my colleagues, explain their roles, and help them understand what the change would mean for them. To rise to this challenge, I first had to understand my own mindset, motivations, strengths, and weaknesses. It was hard work.
Before I pursued the role of CMO, I spent 10 years gaining the knowledge and administrative skills necessary. This included attaining an MBA and pursuing fellowship status in the American College of Healthcare Executives. It was Dartmouth College's Master of Healthcare Delivery Science program that gave me the big-picture understanding of system science for healthcare redesign and the skills to successfully align and support the implementation of local innovation that could be taken to scale. Gaining this knowledge, plus my years of clinical experience, gave me the confidence to proceed.
Healthcare transformation is finally happening now, and I am excited to be part of it.
Carol Ash, DO, MBA, CMO of Robert Wood Johnson University Hospital Rahway. Photo courtesy of RWJBarnabas Health.
HL: You are the first CMO at RWJ University Hospital Rahway. How have you defined the role?
Ash: I was not only the hospital's first CMO, I was the first female CMO at an acute care hospital across our health system. Adding to that hurdle, a year and a half after I started, we had to respond to the COVID-19 pandemic. With no prior CMO to set the example, I challenged myself to use the power of the position to remove obstacles and create opportunities for my colleagues, our patients, and the community we serve.
Along with superb clinical and administrative knowledge, a CMO needs to be humble. I do not have all the answers, and I openly admit my mistakes. I try to let others do most of the talking, so that I can see things from their perspective. My goal is to be a resource for the people who are doing the work. I aim to build respect and trust as well as unite and unlock the potential of our team every day.
HL: What are the keys to success in case management?
At RWJ University Hospital Rahway, we successfully shifted most patients to case management by hospitalists. This allowed us to focus limited case management resources into a multidisciplinary team-based approach with a focus on accurately recognizing, diagnosing, and removing obstacles to management and discharge. The focus was delivering high-quality care in minutes, not hours or days.
Supporting cultural change is hard to do. It was especially hard at RWJ University Hospital Rahway because most staff physicians were in private practice, and they were resistant to change. My primary challenge was to support my physician colleagues in that endeavor when they did not see the need to change.
Ultimately, while dealing with the pandemic in a community hospital entrenched in a culture that still valued fee-for-service, we were able to achieve a significant shift in the number of employed physicians practicing in our hospital from zero hospitalists to 60%–70%. More patients are now under the care of a doctor employed by the hospital versus those in private practice.
What did this mean for our patients? These doctors now have the support of an entire team, which helps them raise the overall well-being of their patients. They have access to nurses, social workers, navigators, and professionals that can connect them with necessary services. We were able to shift care from a model focused on financial outcomes to a model focused on patient-centered outcomes. The best result has been a decrease in hospital length of stay.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
To promote quality care, physicians must shift from a model of professionalism based on self-governance and autonomy to a model based on team-based care.
To aid in change, clearly communicate the new direction, explain roles, and help others understand what the change would mean for them.