The Exec: How CMOs Can Succeed in Medical Staff Governance

The primary elements of effective medical staff governance include shared decision making, harnessing data, and strong physician leadership, according to this new CMO.

Michael Fiorina, DO, was announced as the CMO of Independence Health System on June 10. He joined the health system's administrative team in 2021. Prior to being named CMO, Fiorina served as vice president of medical education and associate CMO of Butler Memorial Hospital and Clarion Hospital.

The are six essential elements to succeeding in medical staff governance, according to Fiorina.

• Strong physician leadership: This starts with engaged physician leaders who understand clinical, operational, and strategic priorities. These leaders must be identified, cultivated, and developed in a coordinated and intentional fashion.
   
• Shared decision making: Physicians must be engaged in the decision-making process through committees, councils, and valuing their input.
   
• Clear roles, accountability, and ownership: The goals of the work assigned to physicians need to be clearly defined and communicated. There must be ownership for the outcomes, particularly in areas such as quality and safety.
   
• Effective communication: Frequent and transparent communication is critical to building trust and facilitating effective problem solving.
   
• Harnessing data: Clinical data and performance metrics should be used to guide decisions to make meaningful and measurable improvements.
   
• Interprofessional collaboration: There must be collaboration across disciplines, not just physicians, to get a comprehensive view of the challenges and solutions.

Michael Fiorina, DO, is CMO of Independence Health System. Photo courtesy of Independence Health System.

Succeeding in community-based care

CMOs and other healthcare leaders face barriers in providing community-based care, particularly in rural settings, according to Fiorina.

"This is a real challenge, given the evidence that many rural areas are struggling to provide care for the people in their communities," Fiorina says.

A primary strategy to provide community-based care is to build strong partnerships with community-based organizations. For example, Butler Memorial Hospital is a member of the Butler County Growth Collaborative, which is a group of political, educational, and business leaders who meet regularly to discuss their challenges and build strategies for serving members of the community. The hospital also involves care teams in community events.

"This puts faces to names and allows us to interact with the people who are our patients," Fiorina says.

Butler Memorial Hospital also shares its achievements with the community, Fiorina explains.

"When we win a quality award or have a provider achieve a new certification, we announce it to the public," Fiorina says. "We need to be our own greatest advocate."

Establishing residency programs

Securing the support of a health system's top leadership is essential in building residency programs, according to Fiorina.

"Our president and CEO was the one who originally approached me with the idea, and we had wholehearted support of the board of trustees," Fiorina says. "Without this foundational support, the concept could not have become a reality."

It is also crucial to gain the support of key stakeholders, Fiorina explains.

"It was vital to get the support of the medical staff through effective communication via the department chairs, who served as key liaisons to the broader medical staff," Fiorina says. "It was also imperative to communicate the goals of the residency program to the other disciplines that would interact with the residents such as nursing and physical therapy."

Next, a health system must build the infrastructure required for accreditation such as hiring faculty and staff to support a residency program, according to Fiorina. Without the proper infrastructure in place, accrediting bodies won't consider an organization a viable site.

"We also utilized relationships built with medical schools to assist us in the application process," Fiorina says. "These institutions are invested in having high-quality residency sites to send their graduates and are very interested in partnering with hospitals."