The Exec: Chief Clinical Officer Shares Keys to Clinical Integration Success

Peter Paige says clinical integration initiatives require inclusion of staff members at all sites of care, adoption of best practices, and explaining why the effort promotes patient-centric care and establishes a unified organization.

There are three crucial elements to successful clinical integration efforts, according to the new chief clinical officer of Westchester Medical Center Health Network (WMCHealth).

Peter Paige, MD, MMM, became the inaugural executive vice president and chief clinical officer of the Valhalla, New York-based health system in September. His prior leadership experience includes serving as chief clinical officer of University of Virginia Health as well as executive vice president, chief physician executive, and chief clinical officer of Jackson Health System.

Paige says three factors drive successful clinical integration initiatives: inclusion, best practices, and explaining why clinical integration promotes patient-centric care and establishes a health system as a unified organization rather than a disparate collection of care sites.

When considering inclusion at large health systems, leaders have to consider how to engage staff across multiple sites of care, Paige explains.

"We have nine hospitals and seven campuses at WMCHealth, and we cover more than 6,000 square miles," Paige says. "When you have big health systems like this, you need to get people from different parts of the health system who work in different roles aligned with the overall mission of the organization."

Clinical integration involves identifying best practices, Paige explains.

"There are many best practices that have been established across the country, and clinical integration involves capitalizing on those best practices whether we have them at one site or multiple sites," Paige says. "You need to identify best practices, then make sure you have incorporated them into your health system."

For example, when Paige was chief clinical officer at Jackson Health System, the organization identified an opportunity to improve perioperative services with adoption of best practices from across the country.

"There are best practices as it relates to key data points that need to be tracked in perioperative services such as timeliness of access, first-case on-time starts, throughput, and turnover time for procedural rooms," Paige says.

Health system leaders must communicate with staff members about why clinical integration initiatives are important, including the ability to provide the highest quality of care to patients as close to home as possible, according to Paige.

"It's also about managing our resources as a network," Paige says. "So, if a patient is at one of our community hospitals and requires a higher level of care, we want to have integrated connectivity so the patient can be transferred seamlessly to the academic medical center and get the care that they need."

Peter Paige, MD, MMM, executive vice president and chief clinical officer of Westchester Medical Center Health Network. Photo courtesy of Westchester Medical Center Health Network.

Boosting Operational Efficiency

Paige says there are several approaches to improving operational efficiency at a health system such as harnessing data and embracing best practices.

"You must understand your baseline data, which allows you to identify your opportunities for improvement," Paige says. "You analyze the data and come up with solutions based on best practices identified across the country. Then you can launch those solutions in pilot phases."

It is essential to track the adoption and implementation of operational efficiency initiatives.

"You need to make sure you are having the impact that you anticipated and to adjust as necessary if your solutions are not working well," Paige says. "Sometimes, solutions do not work as anticipated initially, and they may require tweaking."

Health systems can use scorecards and dashboards with specific data points for service lines to track operational efficiency initiatives.

"For example, in ambulatory care, we track data points such as time to first appointment, time to follow-up appointment, and cancellation rates," Paige says.

An example of improving operational efficiency is ensuring that hospitalized patients receive timely MRI exams.

"You conduct an analysis to make sure you have enough MRI sites for the patients in your care, you determine why MRIs are being ordered and whether they are necessary, then you examine the reading of MRI exams," Paige says. "You want to pull waste out of the system, reduce delays in the system, and make the system more efficient."

Improving operational efficiency has several benefits.

"When you boost operational efficiency with efforts such as reducing delays and making inpatient throughput more efficient, you reduce hospital length of stay, patients have fewer complications because they are not staying in the hospital too long, patient experience improves, and you can take care of more patients," Paige says.

Standardizing Care

Effective efforts to standardize care reduce costs and improve clinical outcomes.

As is the case with clinical integration efforts, inclusion is crucial in adopting and implementing care standardization initiatives, Paige explains.

"Your staff at sites of care need to feel that they are part of the solution," Paige says. "They shouldn't feel that they are being told to do A, B, or C. Their insights are important."

Successful care standardization efforts require health system leaders to communicate transparently with staff members.

"You need to explain why you are standardizing an element of care and share the data that shows good patient outcomes," Paige says. "Staff need to know that a standardization initiative is based on fundamental principles that have been shown to be effective."

Part of achieving staff buy-in for a care standardization initiative is establishing that the primary goal is raising the level of care and quality of services for patients and their communities.

"It's hard for staff members to argue with this philosophy—leaders should not approach standardization as an exercise in us trying to impose our will," Paige says. "This is us trying to create a standardized platform that is going to produce the highest clinical quality result we can achieve for the patients we care for."