The Exec: New CMO Puts Premium on Health Equity

Health equity is a primary concern at Metropolitan Hospital, which serves a diverse community in New York City.

The new CMO of Metropolitan Hospital, which is part of NYC Health + Hospitals, is committed to health equity.

Anitha Srinivasan, MD, MPH, became CMO of Metropolitan Hospital effective June 1. She has held several leadership positions at the hospital, including serving as deputy CMO and chief experience officer. Srinivasan has a clinical background in surgery.

"Promoting health equity is the very core of our mission," Srinivasan says. "Metropolitan Hospital is part of a safety net health system. We are in a vibrant neighborhood, East Harlem, which is very diverse."

The approach to health equity at Metropolitan Hospital is multipronged, according to Srinivasan.

"We need to understand the community around us and the social determinants of health," Srinivasan says. "We need to look at some of the non-medical factors such as mental health issues, housing and food insecurity, and transportation barriers for the community."

The hospital strives to provide culturally competent care. All staff are trained to be culturally sensitive, according to Srinivasan.

"We provide multilingual services—we always give importance to language of preference among the patients," Srinivasan says. "All the medical education literature, the consent forms, and the documents that the patient signs are in the patient's language of preference. So, the patient understands what treatment they're getting."

The hospital places a high priority on looking at data through a health equity lens. Srinivasan explains that health equity data gives leadership an opportunity to think outside the box and innovate with the patient population in mind.

"For example, when we look at a particular service, we like to break down the health equity points," Srinivasan says. "Who is coming here for services? How are we providing these services? What are the differences?"

Anitha Srinivasan, MD, MPH, is the new CMO of Metropolitan Hospital in New York City. Photo courtesy of NYC Health + Hospitals.

Developing a clinical services business plan

Srinivasan has been involved in crafting clinical services business plans for Metropolitan Hospital.

"What we need to do is robust clinical business planning because it is essential for financial health and sustainably," Srinivasan says. "It may appear strange that I'm talking about financial health for a safety net system, but we must be at least sustainable."

The key elements of developing a clinical services business plan include market analysis and community needs assessments, according to Srinivasan.

"We plan our expansions and services according to the needs of the community, so that we are sustainable as a hospital and have strategic alignment," Srinivasan says. "According to the market analysis and needs assessment, we do the hospital's resource allocation."

Metropolitan Hospital has a five-year model for clinical services business planning.

"We can manage expanding a particular service," Srinivasan says. "We take the buy-in from the clinicians. We see if there's a need in the community, then expand a service. The administrators come up with a strategic plan, including input from doctors and nurses, then we present the strategic plan to the hospital's leadership. Once the strategic plan is approved, we are tracked for the next five years."

Clinical services business planning never trumps crucial clinical goals such as patient safety, but running a hospital is similar to running a business, according to Srinivasan.

"It's almost like a commercial enterprise, except we do it with the aim of being sustainable financially and serving the community and improving access," Srinivasan says. "That's where business planning is very important, even if we are a safety net hospital."

Promoting quality assurance

As deputy CMO and now as CMO, Srinivasan has been involved in quality assurance efforts.

"Quality assurance is an ongoing commitment to say we will deliver the highest standard of patient care irrespective of the ability to pay," Srinivasan says. "That is our mission."

A hospital's leadership team must be committed to quality assurance, according to Srinivasan.

"The success of any quality assurance program begins with leadership," Srinivasan says. "We should be good leaders and strive for good quality, and then we can create a culture of safety."

Metropolitan Hospital's approach to quality assurance is data-driven.

"We use data collection through a reporting system where anybody can report any concerns and then we do an analysis," Srinivasan says. "We come up with quality assurance projects for every department so that we can provide consistent, high-quality care."

Keys to success in risk management

Srinivasan plays a significant role in risk management at Metropolitan Hospital.

"I still run the root cause analysis process," Srinivasan says. "It involves identifying and mitigating potential threats to patient safety. That's a primary goal—patient safety."

The hospital has a reporting system for patient safety events that can be used by any staff member.

"When reports come in, we do a daily analysis, and relevant reports are presented to a committee that includes nurses and doctors," Srinivasan says. "When errors occur, we provide staff training, but in a nonpunitive fashion. We look for systemic errors."

Maintaining a nonpunitive workplace environment is essential to promote patient safety because staff members should not feel discouraged to report errors in the future, Srinivasan says, adding leaders have a critical role to play in establishing a nonpunitive workplace environment.

"We try to support our staff, so they don't feel like they're being blamed or cornered," Srinivasan says. "Everybody who sits on the root cause analysis committee goes through training, so we know not to blame an individual for a mistake. We look at systemic causes first so we can improve as a system."