The Exec: New UnityPoint Health-Meriter CMO Shares Keys to Success in Clinical Transformation Initiatives

Effective clinical transformation initiatives embrace a team approach and engage stakeholders in making change, this new CMO says.

There are several factors involved in successful clinical transformation initiatives, according to a new CMO at UnityPoint Health.

Karyn Baum, MD, became market CMO of UnityPoint Health-Meriter in September. Prior to taking on the new position, Baum served as chief transformation officer at Duluth, Minn.-based Essentia Health.

A major factor for succeeding in clinical transformation initiatives is not letting perfect be the enemy of the good, according to Baum.

"You can get obsessed with perfection, but you need to move forward," Baum says. "For example, during the coronavirus pandemic, we had to make decisions based on the best available evidence at the time even if the evidence changed the next day."

A team approach is essential in clinical transformation initiatives, Baum explains.

"You need to spend time upfront to understand the stakeholders involved in transformation and what they need," Baum says. "Then you manage change by making sure the stakeholders understand what is going on and they have input. You need to bring people to the table early and often to incorporate their ideas."

Metrics are also crucial.

"If you ask staff members to do something different to address a problem, then you are obligated to measure the impact on the problem and let the staff members know about the impact," Baum says. "If you measure the impact of a clinical transformation initiative on a problem and you are not generating the desired effect, you must be willing to change your approach. Many initiatives do not work perfectly at first."

One of the clinical transformation initiatives that Baum helped to lead at Essentia Health involved discontinuing the use of pagers by doctors when the health system opened a new hospital. The pagers were replaced by an app on the doctors' cell phones. It was a challenging transition for the doctors.

"Disconnecting doctors from the pagers they had used for many years was not a small change," Baum says. "They had valid concerns about whether they might miss a question about a patient, what would happen when they were driving to and from the hospital, and whether there was adequate coverage for their cell phones."

Baum took a team approach to the initiative, with input from all stakeholders. After working with the IT team, informatics, and other departments, Baum wanted to ensure the doctors’ concerns were heard.

"We adjusted some of the plan based on feedback from the doctors," Baum says. "We reassured doctors that we had contracts with the main cell phone service providers to ensure that we would have coverage throughout the building."

Training and assessment helped ensure that the initiative was a success.

"We trained doctors on how to use the new app on their phones," Baum says. "Then we double-checked that the new system was working as intended."

Karyn Baum, MD, is market CMO of UnityPoint Health-Meriter. Photo courtesy of UnityPoint Health.

Physician leadership development

An important building block for physician leadership development is the recognition that there is a skillset that can be learned to be a good physician leader, according to Baum.

"You need to spend time with the people who have an interest in physician leadership, whether it is meeting with them individually, mentoring physicians one-on-one, or working with them to talk through a challenge," Baum says.

Several skills and areas of knowledge should be part of physician leadership development. Baum explains that physicians in general can benefit from learning about the financial aspects of healthcare.

"It is also helpful to learn about the legal aspects of healthcare as well as human resources," Baum says. "It is important to learn about communication skills and to translate the communication skills needed to work with patients into communication skills to work with other physicians and healthcare professionals."

Aspiring physician leaders should also be well versed in quality and patient safety, according to Baum.

"This includes intervention design, metrics, and how quality impacts finances," Baum says.

Mentoring is a primary element of effective physician leadership development programs, Baum explains.

"An effective physician mentor is a good listener," Baum says. "A physician mentor should ask questions, then see how they can support a physician through their journey to leadership roles."

Baum has benefited from mentorship during her career.

"Some of the most impactful conversations I have had involved the mentor asking me a couple of key questions to have me think about what I wanted to leave behind and what brings me joy in my work," Baum says.

Reducing length of stay

Planning is a primary component of reducing length of stay, according to Baum.

"You need to think three steps ahead," Baum says. "As soon as you admit a patient to a hospital, you should start planning for how to get them to the next level of care safely and effectively. You should engage the patient's family in this process."

At UnityPoint Health-Meriter, the hospital conducts discharge rounds every day with a team that includes nurses, social workers, physical therapists, and occupational therapists.

"This team goes through every patient on their unit to make sure everybody is on the same plan, everybody understands the next steps, and there is a plan to overcome barriers to discharge," Baum says.

CMOs and other clinical leaders must balance efforts to reduce length of stay with discharging patients safely, which, according to Baum, starts with good communication with patients and families.

"You need to set up home care services when that is appropriate," Baum says. "You need to make sure patients have follow-up appointments. It is helpful for patients to have their medications in hand when they leave the hospital."

For some patients, reducing length of stay is not possible.

"While reducing length of stay is important, a CMO should make sure that care teams recognize when a patient needs to stay in the hospital an extra day," Baum says. "Each patient is unique, and some of them need to spend extra time in the hospital."