Westchester Medical Center Health Network's CMO says staff members ''understand the forces behind decisions if they are a part of the process.''
Renee Garrick, MD, executive vice president and chief medical officer of Westchester Medical Center Health Network (WMCHealth), says managing the health system's quaternary care hospital and balancing resources are her top challenges.
Garrick is the clinical leader for the Valhalla, New York–based health system, which features 1,700 inpatient beds at nine hospitals in the Hudson Valley. She recently talked with HealthLeaders about a range of topics, including leadership, physician burnout, clinical challenges now that the crisis phase of the coronavirus pandemic has passed, and workforce shortages. The following transcript of that conversation has been edited for clarity and brevity.
HealthLeaders: What are the main challenges of serving as CMO of WMCHealth?
Renee Garrick: There are two major issues in being the CMO of our network.
First, we are the only quaternary care hospital for this region, which spans several thousand square miles. As the major quaternary care hospital, it means we accept patients at the main hub who need high-end care that cannot be offered at the other facilities in the Hudson Valley. We are a referral hospital not just for our patients but also all hospitals in the region.
From the CMO perspective, that means there is a lot of juggling in terms of having our staff at the ready to accept patients and to be able to juggle inpatients and transfers 24/7. We must be able to do that while taking great care of the patients in our hospitals and the patients who transfer to our medical center. I spend a fair amount of my time making sure we have the best possible staff on the medical side, the nursing side, housekeeping, social work, and dietary to be able to care for a broad range of patients. I also need to make sure that the staff has the time to take care of themselves as well as patients, so their lives are balanced, and they can give the best care possible.
The other challenge is we have a lot of busy practitioners, and they have valid and important resource needs. It takes a lot to balance those needs and know that people understand that you are doing everything you can for everyone to the extent possible. That means there is some sharing that must go on. So, if surgery needs A and B, and neurosurgery needs C and D, and medicine needs E and F, they all must understand everyone's needs as a group. I expend a lot of energy making sure that people understand we are balancing resources and making sure that everyone has access to the best that is available. There's nobody who gets more than another. In the end, it all balances out.
Sometimes, people want to have an enormous amount of add-on resources, and you cannot do that if it is going to hurt a smaller department with equal need. I spend a lot of time speaking to the physicians, the medical staff, and the graduate medical staff so they can all understand how it works. Transferring patients and allocating care—and recruiting and retaining the medical staff—is a big part of what I do. It can be a challenge getting everyone to understand the greater good and the goals of the organization. It takes a lot of listening to make sure you do that well.
HL: How do you persuade colleagues to share resources?
Garrick: I try to be transparent about it. People understand the forces behind decisions if they are a part of the process. You must be aware of the staff you are working with—the medical staff, the nursing staff, and the administrative staff. You must explain your position and how you came to a decision—that is an effective way of building a coalition and having people come to an understanding of why things are being decided the way they are.
I graduated medical school in 1978. My experience has been as long as people are treated respectfully and you are honest about what can and cannot be done, the process resonates with people. A problem is created when facts are not shared, then people make up their own facts. They fill the vacuum with what they might think is the truth. It's hard to rescue the process under those circumstances.
Renee Garrick, MD, executive vice president and chief medical officer of Westchester Medical Center Health Network. Photo courtesy of Westchester Medical Center Health Network.
HL: What is the status of physician burnout at WMCHealth?
Garrick: Over the past year, we have recruited hundreds of providers. In the past three months, we have recruited 100 new nurses. So, we are a resilient organization. Part of that is we are the tertiary care referral center, and we are proud of that.
We are still dealing with COVID. But we have also been dealing with monkeypox—we have given 1,800 monkeypox vaccinations. We are thinking about polio because we are in the Northeast, where polio has had a resurgence. We also are dealing with RSV. So, our staff takes enormous pride in being at the ready and being resilient. We get so much joy out of helping patients on the nursing side and the physician side that our burnout has been less than other organizations.
A big key to physician burnout is the happiness and unanimity of purpose that we share with our nursing colleagues. Our nursing staff just ratified a new five-year contract, with overwhelming support. The core of the contract is to make it clear to our nursing staff that we have an enormous amount of respect for their skill and expertise, and we want to be able to recruit, retain, and reward the best nurses in the country. For doctors to be at their best, they work best when they have nurses who are happy by the bedside. A big part of our resiliency is we partner with an extraordinary nursing staff. That helps with how physicians cope with burnout—having a great nursing staff.
HL: What are your primary clinical challenges now that the crisis phase of the pandemic has passed?
Garrick: For us, the clinical challenges are always being ready for the next stress for the organization. Our staff had to be resilient because in the middle of COVID we had monkeypox, and we were asked by the state to be a referral center for monkeypox. We are also dealing with RSV. So, the clinical challenges are keeping the engine humming while gearing up for the next level because as a quaternary care hospital you must be able to provide basic care and get to the next level.
Right now, we are looking at high-end new radiation oncology equipment and thinking about how to move that part of our service for the region forward. That means recruitment, that means building, and that means growth and development. We are looking at building a new critical care area for the medical center to be able to serve the Hudson Valley with the highest level of care.
The clinical initiatives and clinical challenges are looking ahead to the next things we need to do to always be on the cutting edge. We are asking our people to have their feet in two worlds—the current and the future, where we are thinking about artificial intelligence and outfitting the ICU with bedside ultrasound. It's a big clinical challenge to do the day-to-day care while also planning simultaneously for the next several years to come.
HL: What are the primary efforts you have in place to address workforce shortages?
Garrick: On the medical side, we can attract some of the best physicians in the country because we provide a range of care including quaternary care. We have a good organ transplant program—we do heart, kidney, and liver. We have amazing neurosurgery and pediatric care. We have high-end care, but we are also a large network. So, at our institution, we are lucky because physicians can come to the medical center and ply their trade in complicated cases, then they can go to another hospital and be satisfied taking care of community-level conditions.
One of the advantages that we have in terms of addressing workforce shortages is there is a lot of variation in the kinds of patients that we treat, and physicians like to have the opportunity to see more than one type of patient and tackle more than one type of challenge. Over the past two years, we have credentialled more than 1,000 practitioners in our network, and the wide spectrum of the kind of patients that we see is attractive to young physicians.
We also have a lot of mentoring. When you finish your training, you still want to have somebody near your elbow as a mentor; so, if you have a question or have a complicated case, you have someone to help you. We are proud of the fact that we have a staff here that is stable—the medical staff has little turnover, and we have a lot of opportunities for mentorship. This is important for young physicians, especially the ones who trained during COVID. Our ability to provide mentors makes this network an attractive place to work.
Being an academic medical center also helps us recruit and retain physicians. Having a medical school at our main campus and being able to engage in research is a big part of recruitment and retention. The residents and fellows participate in the research as do the medical students. We love the fact that medical students stay here as residents, and some of them stay on as attending physicians.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
To persuade colleagues to share resources, be transparent about the decision-making process.
A pivotal factor in physician burnout is the quality and unanimity of purpose of the nursing staff.
Mentorship opportunities and engagement in clinical research are major factors in clinician recruitment and retention at WMCHealth.