New Chief Physician Executive: 'You Must Have a Team Around You'

Brian Tiffany, MD, PhD, says ensuring physicians feel that they have a voice in a healthcare organization is the crucial element of physician engagement.

The new chief physician executive of the Dignity Health Southwest Division has developed an executive leadership style that is heavily influenced by his background in emergency medicine.

Brian Tiffany, MD, PhD, has succeeded Keith Frey, MD, in the chief physician executive role. Frey retired in January.

Tiffany has worked at Dignity Health for two decades. Prior to moving into his new role, he served as chief medical officer at Dignity Health's Arizona General Hospital Phoenix. An emergency medicine physician since 1990, Tiffany joined Dignity Health in 2003 as a member of the medical staff at Dignity Health Chandler Regional and Mercy Gilbert Medical Centers.

The Dignity Health Southwest Division includes six hospitals in the Phoenix area, three hospitals in Nevada, and 14 free-standing emergency departments.

Tiffany recently spoke with HealthLeaders about a range of topics, including his new role, promoting clinical excellence, physician engagement, and the coronavirus pandemic. The following transcript has been edited for clarity and brevity.

HealthLeaders: What are the primary elements of your leadership style?

Brian Tiffany: My leadership style grew out of being an emergency physician. That is who I am—I still think of myself as an ER doctor. I still practice, although not at the level that I used to practice.

An ER is a very close-knit team. There is no captain of the ship in the ER—there is very little of a power gap in the ER. An experienced ER nurse will save your bacon as an ER doctor many times through the course of your career. When a nurse says, 'I need you in Room 4,' you do not ask why you are needed in Room 4, you go to Room 4.

You listen to suggestions. You communicate as a team. You take care of each other as a team. I think about leadership in those terms. You know your people. You are present. You are not the boss—you are most responsible for making sure we get to where we need to go, but the whole team must be involved. No matter how small the ER, no ER physician knows everything that is happening in a given moment. But collectively, we know exactly what is going on. That applies all the way up the line to the division-level leadership. No single person can run everything—you must have a team around you.

HL: How do you envision serving as a chief physician executive?

Tiffany: The most important thing is to work effectively together as a division to deliver high-quality healthcare. We have great diversity in our division, from academic teaching facilities to community hospitals, and a significant network of urgent care clinics. What I am here to do is to help us work together as a division—particularly in the physician realm—in the delivery of care to patients at the appropriate level of service. We want to provide care to patients as close to their home as possible at the right level of care and the right site.

HL: What is the biggest challenge you foresee in your new role?

Tiffany: The diversity of facilities is part of the challenge—bringing academic physician groups, employed physician groups, and independent practices together to work as a team. It takes a lot of interpersonal relationship building. It takes team building.

HL: How do you promote clinical excellence?

Tiffany: A big component of clinical excellence is reducing variation in how we deliver care. You need to identify best practices, then adapt them to local conditions—each hospital has its own set of local challenges and its own community—to provide better care.

Over the past six years, the division has been on a journey to achieve high reliability. Some of our hospitals have already gone through that process. A major component of high reliability organizations is teamwork. It's reducing the power gap between physicians and members of the staff. It's helping everyone to work together as a team. Every member of a team should feel the freedom to speak up, ask questions, and stop the line if they perceive that there is a safety concern. That is a way of reducing errors and delivering better care.

HL: Give two examples of your division's approach to high reliability.

Tiffany: Stop the line is a good example. A housekeeper who sees something that does not look right should not feel intimidated about speaking up and saying, 'Is this OK? Should this be happening this way?' No one can penalize someone for bringing up a concern—that kind of questioning should be welcomed at all levels of the organization.

Another big component of high reliability is checks and balances. When a physician writes an order, that order just does not get executed blindly. The order is seen at several levels—the nurse sees that order, the pharmacist sees that order, and we use an electronic health record and there is error checking that occurs in the EHR. Those checks and balances make it very difficult for any error to reach a patient.

HL: How do you build strong physician engagement?

Tiffany: Physicians need to feel heard—that is the biggest component of physician engagement. We conduct physician surveys here to gauge how they feel about the organization and how they like working here. The Number One thing for physicians is to make sure they have a voice—we do a good job at that, but we want to do a better job at that.

For me, in this role, I want physicians to know that I have an open door—that I will listen to their concerns and the organization is interested in their concerns. As in any leadership role, it is crucial that you hear someone's concerns, but it does not necessarily mean that you should do what they think should happen. However, they should understand why you are doing what you are doing. Whether they agree with you or not, they should know that their voice was heard.

As an organization, another major component of physician engagement is that a physician should have absolute confidence that their patients are going to receive excellent care. That goes far beyond the physician—it is the care that is being delivered when they are not standing at the bedside. The organization must perform reliably and with excellence.

HL: What lessons did you learn from being a member of the Dignity Health Southwest Division COVID-19 Incident Command?

Tiffany: It was a lesson in the value of talking with each other. In the Phoenix area, we were six independent hospitals working together. This pandemic has drawn us together in many ways. We must share resources. We must load balance between our institutions. The pandemic got all of our leaders to be more than acquaintances—they got to know each other well and work in the trenches together well.

Another great lesson from the Incident Command is the value of cooperation and working closely with other healthcare entities. There is a CMO group that is constantly talking with Banner Health, HonorHealth, Valleywise Health, and hospitals all over the state of Arizona. We have regular phone calls, so these healthcare organizations can know what is going on in multiple areas. We move resources around as needed. We go as a unified front to the state when we need something.