New Tenet Healthcare Hospital Group CMO Shares Keys to Leadership Success

Adrian "Eric" Ramos, MD, discusses physician leadership, quality improvement, and patient safety.

The key to serving as the CMO for multiple hospitals is understanding the culture at all of the facilities, building relationships, and establishing trust, the new CMO of a Tenet Healthcare hospital group says.

Adrian "Eric" Ramos, MD, was recently named as the new CMO of Tenet's Northern California Group and CMO for Doctors Medical Center in Modesto, California. Tenet’s Northern California Group features six hospitals: Doctors Medical Center, Doctors Hospital of Manteca, Emanuel Medical Center in Turlock, San Ramon Regional Medical Center, Sierra Vista Regional Medical Center in San Luis Obispo, and Twin Cities Community Hospital in Templeton.

Before accepting his new roles at Tenet, Ramos served as CMO of Long Beach Medical Center in Los Angeles County. Prior to working at Long Beach Medical Center, he was CMO for HCA Healthcare's Far West Division, which features eight hospitals in California and Nevada.

HealthLeaders recently spoke with Ramos about a range of topics, including physician leadership, quality improvement, and patient safety. The following is a lightly edited transcript of that conversation.

HealthLeaders: What are the primary challenges of serving as the CMO for multiple hospitals?

Adrian "Eric" Ramos: Every hospital has its own culture, and every hospital medical staff has its own culture. So, the challenges are to understand the culture and see how the CMO can engage in the culture as well as the different goals and missions for the hospital staffs and the hospitals themselves.

Part of this challenge is how I look at the two visions of what a hospital administration is driving toward and their pain points, and how I look at the medical staff and what is driving them and their pain points. I try to be a mediator to help improve the understanding of both parties and to help move processes forward.

You must develop relationships with both administrative staff, nursing leadership, and the medical staff—whether it be the chief of staff or the chairs of the various departments. You must establish these relationships rather quickly and develop ongoing trust.

HL: How does rising to these challenges work in practice?

Ramos: It is a lot like being in private practice, which I was for 22 years. You must be able to enter a room, meet a person, put them at ease, develop a trusting relationship, and do an examination. So, it is in my wheelhouse to develop ongoing trusting relationships.

You need to let people know that you really care. When I first started out in a chief medical officer position, one of my friends and patients told me, "People don’t care about what you know. They need to know that you care." I took that to heart. I listen to people, understand what their concerns are, and try to help them address those concerns.

My work of overseeing eight hospitals at HCA Healthcare allowed me to understand how to scale what I learn and how to scale process improvement among a group of hospitals. The way I do that is to look at different initiatives or processes, then bring all groups to the table. Now, I will be working with six facilities to look at an initiative or a process. I want them to decide among themselves the best practices and what their pain points are, then help them address that.

HL: What are the primary elements of successful physician engagement?

Ramos: Each physician has gone into the profession for a reason, and most of the time it is altruism. They are looking to improve the lives of their patients. So, for me, physician engagement is finding out what drives them and what are their core values. What are the things that really move them? Then you connect those values to the initiatives that you bring to the table.

If there are physicians who like to work by themselves, you give them individual things to solve. For physicians who like to work in group settings, you put them in group settings. If physicians are concerned about safety, you put them in patient safety committee meetings. If physicians like changing processes and looking at complex issues, then you put them in those types of roles.

So, you need to understand the core values and drivers of individual physicians, then put them in the right context so that they can be happy and help the organization.

HL: What are the keys to successful quality improvement initiatives?

Ramos: When we look at process improvement or performance improvement in the quality realm, it is really setting a bar, and not saying, "We are going to be at the median." We want to strive to be the best. So, you need to set the bar high and continue to circle back and make sure that we are moving the ball forward.

You need continuous pressure. You need continuous focus. And you need timeliness in your focus.

For example, there might be initiatives that a hospital is not doing well at. If you do a monthly meeting and you are not moving the needle, then you need to move that meeting to twice a month. If you are still not moving the needle, you need to move that meeting to once a week. I have had initiatives where I have had to do weekly calls, with daily metrics sent to me, so that we could drive change.

I need to have commitment on my behalf to let the team know that an initiative is vital and important to me, and that I am not going to drop the ball or let it go.

HL: Characterize the state of patient safety in U.S. hospitals.

Ramos: Various health systems have attained various parts of patient safety. If you look at a hospital, every hospital has its own culture and its own set of challenges. So, there are some facilities and some health systems that are doing extremely well with patient safety. They are reducing and eliminating patient harm, improving outcomes, and improving metric-driven public data such as door-to-needle times for strokes.

We have made progress in eliminating hospital-acquired infections and hospital-acquired conditions. So, it is very encouraging to see that it has not been just talk. Physicians and physician leaders, nurses and nursing leaders, infection preventionists, pharmacists, and environmental services have come to the table and have helped us address hospital-acquired infections and hospital-acquired conditions.

Until we get to zero harm, we have more work to do. But there are pockets of excellence that are very encouraging.