Memorial Healthcare System's New CMO Shares Vision for Post-Pandemic Healthcare

New CMO says the healthcare stars of the coronavirus pandemic work in nursing, hospital medicine, critical care medicine, and emergency medicine.

Successful chief medical officers build trust with their medical staff, focus on quality care, and attend to the needs of the patient population, the new CMO of Memorial Healthcare System says.

The Hollywood, Florida­–based health system recently named Marc Napp, MD, MS, as senior vice president and CMO. Previously, Napp served as deputy chief medical officer at Mount Sinai Health System in New York, where his responsibilities included leading the health system's emergency management program during the coronavirus pandemic.

HealthLeaders spoke with Napp about a range of issues, including physician engagement, quality improvement initiatives, and his vision for clinical care after the coronavirus pandemic has passed. The following is a lightly edited transcript of that conversation.

HealthLeaders: What are the keys to success in serving as a CMO?

Marc Napp: There are various elements to what a chief medical officer is responsible for, and each one of those elements requires a specific set of characteristics, behaviors, or competencies to be successful.

For example, one of the requirements is dealing well with the medical staff. That requires the ability to engender trust among disparate colleagues. So, building trust is a very important factor.

In the quality arena, where you are responsible for the quality of care that is produced by a health system or individual providers, you must understand what quality is, how to improve quality, what metrics are important, and how to move an organization in a certain direction.

With regard to program development and meeting the needs of your community in terms of the services you provide, you must have an understanding of population health and public health. You need to have a keen awareness of what your community needs and the deficiencies in your set of services that need to be addressed.

HL: What are the primary elements of successful quality improvement initiatives?

Napp: First, there needs to be clarity. There needs to be a "why" for an initiative. Then, there is the issue of consensus building. You need to get the stakeholders to be aware that you want to move a particular performance indicator in a particular direction and what their role is.

The most important factor is getting the people who do the work to embrace change and participate in making change. When I have seen quality improvement initiatives fail it is because they are driven by a single individual who is on a mission—as opposed to bringing the people together who are involved in the process and working together as a team.

When I teach performance improvement, it is not so much about understanding the statistics and being able to figure out how many cycles you need to go through for plan-do-study-act. It is much more about getting the group together to figure out that they want to change and move something forward. It is much more about change management and less about the details of performance improvement.

Once you have the change management skills down, you have applied them, and you have a workforce that is ready for change, then you roll out the tools we use for performance improvement such as being technical about measurement and brainstorming.

HL: What are the main elements of physician engagement?

Napp: You must understand the mindset of physicians, recognizing that there is not a single mindset for a large group of physicians—every physician has his or her own concerns and challenges. It is very helpful to recognize those challenges—you can tap into their concerns and therefore be relevant.

For example, if there is a solo practitioner who is a primary care physician who practices in an office where the spouse happens to be the office manager, that is a very different set of circumstances than a large medical group. It is important for the chief medical officer to understand the stressors in every setting, be able to relate to them, and have an approach to engagement that seeks to be respectful of those stressors and those demands.

In our health system, we have many different constituencies. We have solo practitioners, we have small group practices, we have a large employed group, and we have contracted services. Listening to all of them is very important. In the short time that I have been here, I have been spending most of my time meeting people. I want to know people by their first name. I want them to know that they can call me—whether it be good news or bad news. Physicians need to know that they are listened to and that if they have a concern, they can bring it forward.

The next level is acting on concerns. When something turns up that is of importance to a member of the medical staff or large numbers of the medical staff, there needs to be an action plan to address it. That action plan must be executed and there need to be results.

HL: What is your vision for clinical care after the coronavirus pandemic has passed?

Napp: I was in New York for the peak of the pandemic in March, April, and May of last year, and I remember thinking about who the stars of the pandemic were during that surge. It was nurses, hospital medicine, critical care medicine, and emergency medicine physicians—those four disciplines. None of them tend to be the people who get the headlines for the miracles of healthcare. You hear about the cardiac surgeon who does a major heart transplant or some other specialist who does incredible work.

I have been hoping that hospitals would invest more in nursing, hospital medicine, critical care medicine, and emergency medicine, and less so in the areas that drive better funding for hospitals. I do not think that is going to happen. It is going to go back to where it was because the healthcare industry has faced immense costs and many hospitals are in horrendous shape due to the pandemic. There is going to be even more impetus to get back to pushing high-revenue specialties.

Ultimately, we must ensure that our infrastructure specialties—nursing, hospital medicine, critical care medicine, and emergency medicine—are supported and always maintained fully. We also must invest in infectious disease medicine and infection control—we have seen how important those specialties are in delivering healthcare safely.

HL: Gauge the long-term impact of the coronavirus pandemic on healthcare.

Napp: In the big picture, COVID is going to settle down. It will end up in the background in the way that other illnesses are that are recurring. It will ultimately be like a bad flu, and most people will either have immunity to it or they will have an immune system that can fight it. Some people will still get sick and die from COVID just like the flu.

From that perspective, we are going to pick up from where we left off in terms of the experiments in population health. How do you manage a population better and more cost effectively? And how do you craft the distribution of a workforce that meets the needs of the population best? We have not solved those issues, but those are the issues that are going to come back up to the surface when the pandemic settles down.

One of the impacts of COVID that will linger after the pandemic settles down is going to be the loss of members of the healthcare workforce. There already are lots of retirements. We are losing large numbers of healthcare providers. Those numbers will get replenished—there are a lot of people who want to be doctors, nurses, pharmacists, and technologists. But there will be a period of time when we have a labor shortage.

Related: Physician Leader: Culture Critical to Achieving Health System Goals