The Exec: New CMO Shares Keys to Success in Service Line Management

Successful service lines have a vision and clearly defined expectations, this CMO says.

As a former hospital clinical chief of cardiology, the new CMO of Robert Wood Johnson University Hospital Somerset has expertise in running effective service lines.

Anthony Altobelli, MD, became CMO of Robert Wood Johnson University Hospital Somerset, which is part of RWJBarnabas Health, in early September. Prior to being named CMO, held the role of interim CMO at the hospital for a year.

The keys to success in operating an effective service line include identifying a physician leadership team and ensuring that there is a clear vision for the service line, according to Altobelli.

"Sometimes, the vision can be aspirational, which is fine because there should always be some aspiration for everything we do in healthcare," Altobelli says. "But the vision for a service line should include expectations. Those expectations need to be clearly defined, and they need to be communicated clearly."

An effective service line should have dyad leadership, with a physician leader paired with an administrative leader, Altobelli explains, adding there also can be triad leadership that includes a nursing leader.

Data is a driver of an effective service line, according to Altobelli.

"You should have data-rich report cards that show how you are doing as a service line," Altobelli says. "Internally, data allows you to compare what you do to what you would like to do. Externally, there are many data performance evaluators such as national organizations that help you set standards."

Data guides service line leaders and helps them focus on outcomes, Altobelli explains.

"Data helps you when performance changes from moment to moment," Altobelli says. "When we start to see patterns or outcomes going in the wrong direction, we must be responsive to the data."

Effective communication is crucial for a service line and an area where service line leaders are often challenged, according to Altobelli.

"Service line leaders may communicate expectations but when there is a deviation from expectations, leaders must step in to ensure that staff understand that expectations have not been met and get feedback from staff on why they think expectations were not met," Altobelli says.

Anthony Altobelli, MD, is CMO of Robert Wood Johnson University Hospital Somerset. Photo courtesy of RWJBarnabas Health.

Elements of successful medical executive committees

A medical executive committee is the physician and advanced practice provider leadership of a hospital. A medical executive committee works with the administrative leadership of a hospital to provide oversight as well as self-evaluation and self-monitoring of the medicine that is practiced within the hospital.

One of Altobelli's prior leadership roles was serving as a board member of the Robert Wood Johnson University Hospital Medical Executive Committee. There are several primary elements of effective medical executive committees, according to Altobelli.

"It is important for a medical executive committee to communicate effectively with the members of the medical staff," Altobelli says. "The committee should also work with the administration on the strategic focus of the hospital and the medical staff."

A medical executive committee needs to work closely with hospital administrators on establishing and aligning priorities for a hospital, Altobelli explains.

"The committee needs to help administrators prioritize the key issues and serve as a partner with the administration so that information can be cascaded to the members of the medical staff," Altobelli says.

Effective medical executive committees have strong leadership teams that usually consist of a president, vice president, and treasurer, according to Altobelli.

"They are the ones who set the tone for the culture of the medical staff," Altobelli says of committee officers. "Establishing that culture can include credentialling, privileging, peer-review processes, and constant evaluation of quality and safety."

A medical executive committee also needs to provide leadership for physicians in areas where a hospital makes significant investments, Altobelli explains. For example, Robert Wood Johnson University Hospital Somerset has invested heavily in robotic surgery.

"We have made a capital investment in robotic technology, and our physicians understand that investment must generate benefits for patient care—there has to be a patient need to justify the capital expense," Altobelli says.

Effective risk management

A hospital CMO should be involved in risk management such as ensuring there is a systematic process for identifying risks, according to Altobelli.

"You want to identify risks before they manifest in a problem," Altobelli says. "You should assess the threat of a risk, which could be a threat to the safety of patients or a threat to the safety of hospital employees. Then you should try to control the threat and seize opportunities to minimize anything that challenges the mission or vision of the hospital."

The main strategy for controlling a threat is bringing the right people to the table who can help hospital leaders to understand the threat, Altobelli explains. By enlisting the right people, CMOs and other hospital leaders can understand whether the threat impacts patient care or affects the safety of employees.

CMOs and other hospital leaders should dispel notions among their staff that risk management is an exercise in avoiding bad publicity, according to Altobelli.

"Avoiding bad publicity is not what threat-risk assessment involves," Altobelli says. "Anytime you are providing medical services to a patient, there is always risk involved. What we must do is mitigate that risk."