The Exec: A CMO's Guide for Effective Care Coordination

In the hospital setting, care coordination often starts in the emergency department, this CMO says.

Care coordination is an important consideration for CMOs because patients often interact with multiple care providers when they receive services for a health condition, the new president and CMO of Newport Hospital says.

Tenny Thomas, MD, was named president and CMO of Newport Hospital in July. Newport Hospital, which is in Newport, Rhode Island, is part of Brown University Health. Before taking on his new position at Newport Hospital, Thomas was CMO of Beth Israel Deaconess Hospital-Plymouth.

In the hospital setting, care coordination often starts in the emergency department, where physicians and nurses provide care to patients that can involve interactions with providers in several specialties, according to Thomas.

"You need care coordination involving staff members such as case management, social work, and pharmacy," Thomas says. "The staff members who are impacting the patient need to coordinate their care, so that the patient has a safe discharge, can get back to their primary care doctor, and not have to come back to the hospital."

In general, Thomas says the primary element of success in care coordination is ensuring there is alignment between key stakeholders who are providing care to a patient.

For example, Thomas helped achieve this kind of alignment in a care coordination initiative designed to reduce hospital readmissions.

The initiative featured a multidisciplinary group that included inpatient and outpatient providers, pharmacists, care transition staff such as social workers, and case managers. Members of the group worked together to make sure that patient information was available to every provider working with a patient and to come up with strategies to make sure patients had access to specialty care as needed. Another goal of the group was to make sure that patients got the services they needed despite their social determinants of health.

Generating positive outcomes through care coordination helps to drive alignment between care providers.

"Success begets success in care coordination," Thomas says. "As you start seeing better quality scores and better patient satisfaction, that creates an incentive for different providers to participate in care coordination efforts."

Tenny Thomas, MD, is president and CMO of Newport Hospital, which is part of Brown University Health. Photo courtesy of Brown University Health.

Culture critical in quality improvement and patient safety

Health systems and hospitals must have a culture that supports quality and patient safety, according to Thomas.

"Quality and patient safety are the main components of the engine that make a healthcare organization run effectively," Thomas says. "It is important to build that culture in the frontline staff as well as among the leadership of the organization."

There are several elements in building a culture that supports quality and patient safety, including safety mechanisms like checklists, Thomas explains.

"You need to have a strong reporting culture about things that are happening in your health system or hospital," Thomas says. "You need to have daily or weekly reviews of incident reports to determine whether there are serious quality or safety concerns that need to be addressed."

Promoting a just culture is crucial, according to Thomas. This means not focusing on individual faults when something goes wrong.

"You need to understand the reasons behind when something goes wrong, which is often a process issue," Thomas says. "You need to conduct root-cause analyses to understand what went wrong, then modify processes as needed."

One area where a CMO can have a positive impact on quality and patient safety is hospital-acquired infections, Thomas explains.

"I have made sure that a hospital adopts best practices, which have been validated in the literature and across different organizations," Thomas says. "These evidence-based practices can decrease hospital-acquired infections such as catheter-associated infections, central-line infections, and bed sores."

Improving patient flow in the hospital setting

To improve patient flow in a hospital, prioritization of services and making sure there is alignment between different departments is essential, according to Thomas.

"The key to success is clear and transparent information flow between all of your departments, including radiology, ancillary services, and laboratory services," Thomas says. "A CMO needs to help hospital departments align their prioritization. For example, departments should be aligned on the different elements of care that patients need, which helps improve patient flow."

Thomas says one way to align priorities between departments and promote transparency is to create a multidisciplinary group to standardize operations within a hospital on a daily basis, so that care is prioritized for patients who are going to be discharged to provide timely care.

Harnessing data is a primary factor in improving patient flow, Thomas explains.

"If there is a particular group of patients who are being delayed from being discharged because of the lack of a resource, if you can recognize this situation through data, then you can invest in that resource to make sure it is expeditiously available to boost patient flow," Thomas says.

For example, a hospital may have a CT scanner and an MRI machine, but data shows that there is a lack of technicians to provide imaging on a timely basis.

"In that case, you can bring in more technicians because the demand for the service is so high," Thomas says.