The Exec: Hamilton Medical Center CMO on Incremental Successes in Change Management

In healthcare, attempts to make changes quickly at a grand scale are often unsuccessful, this CMO says.

The primary element of success in change management is to pursue a strategy that emphasizes small and incremental changes, according to the new CMO of Hamilton Medical Center in Dalton, Georgia.

Ricardo Perez, DO, JD, became vice president and CMO of Hamilton Medical Center in August. Hamilton Medical Center is part of Vitruvian Health. Prior to taking on his new role, Perez held several leadership positions at Jefferson Health, including regional chief of hospital medicine at the health system's east region, vice president of Jefferson Medical Group, and associate CMO of Methodist Hospital.

"In general, the only time you can make large changes rapidly is in crisis situations, where you have a limited amount of time to make change happen," Perez says. "For effective change management, you want to follow a strategy that pursues small and incremental changes, then you build up to what you want in terms of large-scale change."

In healthcare, attempts to make changes quickly at a grand scale are often unsuccessful, Perez explains.

"People get turned off if you make large changes in a short period of time," Perez says.

Beyond the strategy of pursuing change on a small scale, CMOs and other clinical leaders need to have stakeholder involvement and engagement as part of change management, according to Perez.

"If you are going to be affecting people's daily work lives, your best bet for success is to make sure that those people have some representation at the table," Perez says. "Once you have stakeholders at the table, they can become advocates and catalysts for change because they will have an intricate understanding of why change needs to happen."

Ricardo Perez, DO, JD, is vice president and CMO of Hamilton Medical Center in Dalton, Georgia. Photo courtesy of Vitruvian Health.

Effective physician recruitment and retention

When a health system or hospital is recruiting physicians, it is important to not only promote the organization but also the community, Perez explains.

"Most physicians have families, and they want to know there is a solid school system for their children and make sure there are good neighborhoods where their family can live," Perez says.

CMOs and other clinical leaders also should reassure physician recruits that they would be working with good staff members, according to Perez.

"When I have done physician recruiting, I have handed out the phone numbers of team members, so the recruits could get their side of the story," Perez says. "This gives recruits an opportunity to bond with future colleagues, and it shows you are not trying to hide anything. You create an element of trust, which is a linchpin in terms of recruitment."

The magic number for physician retention is three years, Perez explains.

"If you can keep a physician for three years, most of the time you solidify their place in the organization, and they feel comfortable in the environment," Perez says. "If you can keep a physician for three years, you can probably keep them in the organization for as long as 10 years."

A strong onboarding process is crucial for physician retention. According to Perez, the basics of onboarding include conducting an orientation, hosting training on the electronic medical record, and making sure that physicians know people in the organization.

"But you need to go beyond the basics and provide strong follow-up," Perez says. "Supervisors should do check-ins with new physicians weekly for the first month, monthly for the next two-to-three months, then on a quarterly basis."

Structured and timely check-ins with new physicians ensure that any issues or problems they encounter can be addressed in real time.

Succeeding in population health

There are three primary elements of a successful population health program, according to Perez.

"You need to increase care access," Perez says. "You need a good tracking mechanism to measure how you are performing. And you need to expand your footprint to maximize your patient population."

With fee-for-service remaining the dominant model of healthcare finance, economics must be a consideration in a population health strategy, Perez explains. Under the fee-for-service model, patients who receive services in an acute-care setting generate more revenue than patients who receive preventative services in the outpatient setting, which is a hallmark of population health.

"With population health, you need to maintain the health of the population while expanding the patient population," Perez says. "If you expand your population, you will inevitably get patients who need your acute-care services, which replaces the revenue you lose by providing preventative services."

Breast cancer is an example of where a large patient population is necessary to make population health programs work economically, according to Perez.

"From a population health standpoint, you want to limit the number of breast cancer cases through prevention and maintenance programs," Perez says. "But from an economic standpoint, you still need to have patients receiving acute-care services such as diagnostic imaging, surgical procedures, radiation, and chemotherapy."

Intersection of law and medicine

One of Perez's professional assets as a clinical leader is an understanding of the legal aspects of practicing medicine.

"There is contractual law such as vendor contracts, physician employment contracts, and professional services agreements," Perez says. "There is the regulatory piece, including Joint Commission accreditation and comprehensive stroke center accreditation."

Perez explains that there are many laws that apply specifically to healthcare. There is the Stark Law, which is related to physician self-referrals. There is Obamacare, which has a plethora of legislation such as the creation of accountable care organizations. There is the Medicare Anti-Kickback Statute. There is the Emergency Medical Treatment and Labor Act, which requires hospitals to treat patients in emergency rooms regardless of their ability to pay.

CMOs and other clinical leaders should be aware of liability and risk related to care quality, according to Perez.

"Health systems, hospitals, and clinicians need to practice medicine at the national standard of care," Perez says. "You need to provide adequate medical services that abide by the standard of care, or you can put your organization at risk or clinicians' licensure at risk."