The Exec: CMOs Must Establish Trust to Successfully Engage Clinicians

An element of clinician engagement is giving them meaningful ways to influence a healthcare organization, a new CMO says.

To be successful in clinician engagement, healthcare organizations must give clinicians ways to influence the institution, says the new CMO of Medical City Denton and Medical City Argyle.

Glenn Hardesty, DO, was named CMO of the Denton, Texas hospital and its Argyle campus in August. He previously served as assistant CMO at Medical City Dallas.

Medical City Denton is an acute-care hospital and Level 2 trauma center that has 232 licensed beds; Medical City Argyle has 12 licensed beds. Both are part of Medical City Healthcare, a division of the HCA Healthcare health system.

Hardesty says clinician engagement is more of a philosophy than a series of interactions.

"Just because you have a medical staff golf tournament doesn't mean that you are engaging the physicians," Hardesty says. "You want to make sure that they have real input into the organization. You want to build structures so that they have meaningful ways to contribute to the health system and to make clinical decisions."

Medical City Healthcare has medical staff structures at each of its hospitals, according to Hardesty.

"How you utilize those structures can vary from facility to facility and health system to health system," he says. "We use the medical staff structures to hear the voice of the clinicians and to drive change. We also do an annual physician engagement survey to identify things that are top-of-mind among our physicians."

CMOs need to meet physicians where they are and actively listen, Hardesty explains.

"You don't want to pay lip service," he says. "You want to make sure that when physicians tell you something important, you take action when possible. If you can't take action, you need to tell the physicians why."

CMOs need to establish trust with their clinicians to engage them successfully, according to Hardesty.

"Without trust, engagement does not work," he says. "You build trust by experience over time. You can't come in on Day 1 and engage clinicians. It takes time to build trust. Trust is something that you must earn. You must have multiple encounters, and those encounters must be seen to have integrity."

Glenn Hardesty, DO, is CMO of Medical City Denton and Medical City Argyle. Photo courtesy of Medical City Healthcare.

Promoting quality care

There are two primary factors to promoting quality care in the hospital setting, according to Hardesty.

First, nursing is crucial to promoting quality.

"You must have nursing onboard in a quality plan and quality efforts to be successful," Hardesty says. "If you do not have the nurses on your side, if they do not have the bandwidth, if they do not have the understanding, your quality efforts are for naught."

The second factor is leadership visibility.

"Visibility as a leader goes a long way in promoting quality," Hardesty says. "When I left Medical City Dallas and came to Medical City Denton, the nurses gave me some advice. They said I was very visible, and I needed to keep that up, particularly with the nursing staff."

A major quality initiative that Hardesty helped lead at Medical City Dallas was limiting C. diff infections.

"With a quality initiative such as C. diff reduction, we found it takes everyone to be successful," Hardesty says. "It involved nursing and environmental services, for example. If the rooms are not cleaned properly, you can contaminate one patient to the next."

Part of the initiative involved targeting patients who were at high risk of infection.

"At Medical City Dallas, C. diff reduction was a challenge because there were specialized service lines such as bone marrow transplant that had high-risk patients," Hardesty says. "Those patients are extremely immunocompromised, and C. diff is easily passed in those kinds of units."

Key elements of the C. diff reduction initiative included training nurses on infection prevention, ensuring environmental service staff cleaned patient rooms effectively, and bolstering testing for C. diff.

"We wanted to know when C. diff tests were ordered and to make sure tests were ordered appropriately—that was a big part of what we did," Hardesty says. "We tested patients on arrival at the hospital if we suspected they had C. diff to identify patients early on, so those patients could be isolated and not expose other patients."

The C. diff reduction initiative generated positive results.

"When we started the initiative, we were having several cases per month at Medical City Dallas, and when I left the hospital, we were down to a small handful of cases per month," Hardesty says.

Risk management

In the hospital setting, risk exists everywhere, according to Hardesty.

"The key to risk management is to avoid engaging in unnecessary risk," Hardesty says. "You need to keep the preoccupation with failure front-and-center when dealing with risky situations."

Care teams should compare the alternatives before moving forward to avoid risk, Hardesty explains.

"For example, in the emergency department, you don't want to make moves until you are ready," he says. "You want to move appropriately and deliberately. You want to avoid rushing to judgment. You should pull back, use the resources you have at your disposal, make a decision as a team, then move forward."

Risk management and patient safety have a common theme, according to Hardesty.

"In risk management, you want to identify scenarios before they escalate," he says. "When it comes to mitigating risk, it helps to recognize risk early and address it sooner rather than later."