New CMO: 'You Need to be Impartial and Fair to Everyone'

New regional CMO at Dignity Health shares perspectives on leadership, patient safety, quality initiatives, malpractice, physician oversight, and graduate medical education.

A key component for chief medical officer success is impartiality, a new regional CMO at Dignity Health says.

Victor Waters, MD, JD, was recently named CMO of Dignity Health's Arizona Central and West Valley Market. He will provide strategic leadership for patient care, safety and quality, and physician oversight at Dignity Health St. Joseph's Hospital and Medical Center, St. Joseph's Westgate Medical Center, the Dignity Health Cancer Institute at St. Joseph's, and two freestanding emergency departments.

Waters' previous administrative roles include serving as CMO of Dignity Health St. Bernardine Medical Center in San Bernardino, California, and serving as interim president and CEO of Nexus Fort Washington Medical Center in Fort Washington, Maryland. He has experience in graduate medical education, including serving as a faculty member and Dignity Health physician liaison at University of California Riverside Medical School.

HealthLeaders recently talked with Waters about a range of issues, including hospital quality initiatives, patient safety, and graduate medical education. The following transcript of that conversation has been edited for brevity and clarity.

HealthLeaders: What are the keys to success for a CMO?

Victor Waters: Being neutral is important. It is like being a parent. If you have two children, you show neutrality and that you care for both. Favoritism in a climate as a leader is never helpful. You need to be impartial and fair to everyone. You need to be seen as objective to lead a medical staff and different departments. You need to be objective with private doctors, surgeons, intensivists, and long-term care facilities, for example. Whatever branch of service that you oversee, you should appear to be fair. That is a cornerstone of success for a CMO.

Second is to be able to use the toolkit of communication effectively. Those are things that physician leaders do not learn in medical school and residency training. They often learn through trial and error. I learned my communication toolkit through my law degree—how to communicate more effectively, how to address certain parties, and how to address contentious issues. That toolkit has benefited me as a leader.

Lastly, you need to be able to acknowledge when you are wrong. I am not fault free. In administrative roles, sometimes we miscommunicate. We misunderstand or just make a wrong decision based on whatever facts that we knew at the time. It is important to show humility for physicians, staff, nurses, and other leaders to respect you as a leader.

HL: What is a primary element of promoting patient safety at hospitals?

Waters: One of the basic keys is establishing safety huddles—they are a portal for all hospital staff including physicians to share any safety concerns. When you have a group that can be onsite or remotely, as we have done during COVID-19, you have a venue to share any safety concerns from almost every department. That is the landmark model for safety.

1. It raises administration support to hear safety issues.
    
2. It allows communication from anyone to share safety concerns.
    
3. You have broad stakeholders from every department—from nutrition, to clinical, to ICUs, to nursing, to others—to hear those safety concerns.

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

Waters: What I have found as a CMO, and being successful in quality initiatives, is recruiting the right team, and the key ingredient in having the right team is having a physician champion. You need a physician champion who is truly passionate about the measure you are seeking to improve. It may not be just one physician champion for a quality measure—it may be more than that depending on the complexity of the initiative.

For example, you may want to address sepsis and deaths related to sepsis. You can have many different types of team members on a sepsis initiative. The goal would be to have nursing, a key physician leader, and a key ICU physician because severely ill sepsis patients end up in the ICU.

Another primary element is having frequent meetings and looking at data in real time. Sometimes, if you do not keep ahead of what is going on with a particular quality metric, then you cannot intervene soon enough to make corrections. What flows from having the right team is their ability to analyze the data, look at opportunities, then develop a proactive action plan instead of looking to the past. Looking at data in real time is crucial to managing and leading a quality initiative.

HL: Give an example of a way to mitigate malpractice claims against physicians.

Waters: We have a program at Dignity Health that I have been proactively involved with and has shown success called Communication and Optimal Resolution (CANDOR).

If there is a bad event or an event that is at risk for liability, because there has been harm to a patient, and there is a certain amount of information that the patient does not know, in general, the culture has been to not say anything. That fuels the fire of the family members and often leads to litigation. Anger is what triggers malpractice claims.

The CANDOR program brings together the family members with the doctors, nurses, and anyone else who has been involved in a meeting where people can speak freely. The CANDOR meetings bring about closure because the doctors can share what happened and the family can ask questions. It is an opportunity for the doctors to say they are sorry for what happened. Saying you are sorry does not mean you are taking blame. It shows empathy for what the patient and the family have gone through, and it brings about closure.

HL: When there has been an adverse event involving a physician, how can a hospital conduct physician oversight?

Waters: When there has been a mistake or a misstep, physician oversight involves medical staff, leadership, and my role. What we have is a process. The first thing I practice as a physician leader is not to rush to judgment. I do not want to assume that I have a bad doctor. I look at an adverse event, and we have a process involving peer review where the doctor's peers look at the event and why it happened.

Many adverse events may not be tied to a physician. They may be tied to a process that failed, and the physician may be caught up in the process.

The physician should have an opportunity to speak about an adverse event and learn from it. If there is a pattern that is concerning, it rises to another level that we address. It may be something that we need to stop the surgeon or physician from doing. But overall, when adverse events happen, the mission is to treat the physician with dignity and respect, to look at the event objectively, to look at the facts, and to have an action plan that benefits everyone including the physician.

HL: What are the primary elements of good graduate medical education programs at hospitals?

Waters: Good graduate medical education requires physician leaders who are truly engaged and truly passionate about teaching. That is the starting point. If you do not have that, you cannot have a successful program; otherwise, the residents will feel they are just worker bees. They do not just want to be people doing a job. They want to learn. They want feedback. They want mentorship. So, you need physician leaders who are engaged in graduate medical education.

Second, the attending physicians that rotate with residents must be engaged in teaching, must not be overly critical, and must be patient because working with residents does slow down their normal process, whether it is in the operating room, on a hospital floor, or in a clinic. There is a real benefit if attending physicians are committed to teaching—they can share their experience.