The Exec: Chief Clinical Officer Shares Keys to Service Line Success

Successful service lines have physician alignment, operational accountability, effective communication, robust data analytics, and a grasp of quality outcomes, this chief clinical officer says.

The new chief clinical officer of the Bon Secours Richmond market has extensive experience in managing service lines.

David Hasleton, MD, became chief clinical officer of the Bon Secours Richmond market in February. Prior to joining the health system, he served as CMO of clinical shared services at Intermountain Health. The Bon Secours Richmond market is part of Bon Secours Mercy Health.

There are five components to operating a successful service line, according to Hasleton.

• Strong physician alignment along with clear expectations and accountability
   
• Clear operational accountability, with physician, advanced practice provider, and operational leaders understanding their roles
   
• Clear and effective communication
   
• Robust data analytics
   
• Solid grasp of quality outcomes

When it comes to physician accountability, there must be clear leadership in a service line, Hasleton explains.

'For example, if you have a radiation oncologist who is new out of fellowship and is starting to deliver care at a hospital, there needs to be someone responsible for this doctor's outcomes," Hasleton says. "Someone needs to be responsible for mentoring, training, and teaching this doctor about the clinical pathways that are already in place."

In a service line such as oncology, there needs to be a physician leader, according to Hasleton.

"That oncology leader is a general leader," Hasleton says. "Underneath that general leader will be specific leaders for areas such as breast cancer, surgical oncology, and radiation oncology. The structure must report up to one individual such that there is accountability for one person to oversee the service line."

In terms of operational accountability, there is usually a dyad team, with a physician leader at the top of the service line along with an operational partner, Hasleton explains. In the oncology example, at the top of the leadership structure you have an oncology physician and an operational dyad partner who have clear expectations and work together seamlessly.

"The operations leader helps drive operational efficiencies along with the physician leader," Hasleton says. "The physician leader drives clinical standardization and efficiencies in conjunction with the operations leader because you cannot separate one from the other."

Communication is essential because frontline providers are involved in the process of creating clinical pathways, according to Hasleton.

"This is a co-creation between leadership and frontline providers," Hasleton says. "It is not a top-down approach."

The communication back and forth between the top physician in a service line and the frontline workers, whether they are physicians or advance practice clinicians, is a bi-directional flow, Hasleton explains.

"People must feel empowered to bring up quality issues, safety issues, organizational structure issues, and how improvement can be achieved," Hasleton says.

When a health system builds a service line, there are certain metrics that make sense, and they must be evaluated with data analytics, according to Hasleton.

"In oncology, you have metrics for outcomes for specific diseases," Hasleton says. "Using data analytics to analyze those metrics then drives care forward. You know where you are, and you know where you need to be."

For a successful service line, you need robust data that is flexible and dynamic to meet the needs of the situation, and dashboards are also essential, Hasleton explains.

"It's like driving a car—you have critical information in front of you such as speed and fuel level," Hasleton says. "You need a dashboard for every service line that people can see to know whether they are winning or not."

Service line leaders should look at quality outcomes that are specific to a disease or specific to the service line, according to Hasleton.

"In emergency medicine you look at quality care such as sepsis measures—are we meeting sepsis goals and targets?" Hasleton says. "Quality outcomes are built upon standardization so you can deliver on the quality. You also look at readmission criteria, mortality, morbidity, and length of stay. You need to have data metrics to deliver on the quality."

David Hasleton, MD, is chief clinical officer of the Bon Secours Richmond market. Photo courtesy of Bon Secours Mercy Health.

Fostering provider satisfaction

As chief clinical officer, Hasleton is charged with boosting provider satisfaction.

"When we improve the satisfaction and engagement of our physicians and advanced practice clinicians, and when they can speak their mind in a safe manner, quality and safety follow suit," Hasleton says. "In addition, the patient experience is improved."

It comes down to having dialogue and developing a culture where providers feel heard, according to Hasleton.

"I talk with providers about how I can help them feel more fulfilled at work," Hasleton says. "I talk about how we can foster a better culture, so the providers feel better supported. When providers feel better about what they are doing, patient experience goes up."

Hasleton has a process to promote engagement and satisfaction among providers.

"When I speak with the frontline physicians and advanced practice clinicians, they speak, and I listen. I act, then I follow up," Hasleton says. "It is a cycle. When providers speak, and we do nothing about the issues they raise, we destroy the ability to improve provider engagement."