New Chief Clinical Officer: Empower Entire Workforce to Improve Safety

AdventHealth's new division chief clinical officer views seizing opportunities to improve facilities as a top priority.

Altamonte Springs, Florida-based AdventHealth has created a new chief clinical officer position for the health system's Central Florida Division.

Neil Finkler, MD, was recently named to fill the new post. A gynecologic oncologist by training, Finkler has previously served as chief medical officer of the AdventHealth Medical Group and chief medical officer of AdventHealth Orlando, which is the health system's quaternary hospital.

AdventHealth's Central Florida Division spans seven counties, and features more than 20 hospitals, 300 AdventHealth Medical Group physician practices, 35 urgent care centers, and 6,000 physicians and advanced practice providers.

HealthLeaders recently held a conversation with Finkler about the new chief clinical officer role, the challenges of overseeing a far-flung clinical enterprise, patient safety, and physician engagement. The following is a lightly edited transcript of that discussion.

HealthLeaders: Why did AdventHealth create this new chief clinical officer role?

Neil Finkler: This reflected the importance of making sure that we deliver on our service promises. Most notably, this new role is charged with making sure that we deliver the highest quality of safe and effective care throughout our facilities. We believe each of our facilities must function in unison. So, the care that you get at one facility should be identical to the care that you get at another facility, and we expect the outcomes to be similar.

We obviously understand that there are certain things that only the quaternary facility can do such as ECMO or transplants. But if you come in and you are treated for pneumonia, that treatment should look identical across our entire clinical spectrum.

In addition, we started to recognize that there was more than just the acute care side, which is where I have spent most of my career. We have a whole other aspect of our health system where most patients receive their care outside the walls of our hospitals. We have called that care "integrated health services." I also have oversight for the integrated health services world as well as the acute care world.

Healthleaders: What constitutes integrated health services at AdventHealth?

Finkler: The easiest way to think about integrated health services is everything that is outside the walls of the hospital. It includes physician offices, free-standing radiology and laboratory services, skilled nursing facilities, long-term acute care facilities, transition clinics, and infusion clinics.

HealthLeaders: What are the primary elements of this new chief clinical officer role?

Finkler: The most important thing for me to understand is the opportunities within each of our facilities. I particularly look at this from the standpoint of clinical excellence. Our division has several parameters that we use to assess clinical excellence. The three major ones are the Centers for Medicare & Medicaid Services five-star rating, the Leapfrog rating, as well as ranking in the top quartile of national mortality rates using the Premier Healthcare Database.

In addition, there are other parameters that we look at. We know that healthcare is constantly evolving, which means that the parameters and the metrics that we use are also changing. It is our job to make sure that we are on the spectrum of continuous improvement.

Regarding the CMS stars rating, AdventHealth Orlando, which includes the seven hospitals operating under the Orlando license in Orange, Osceola, and Seminole counties as well as AdventHealth Daytona Beach were recently awarded five stars. This is a great accomplishment, and it represents the skilled physicians and the collective effort it takes to bring excellence to the table. Only 13.5% of all hospitals are five-star ranked. These ratings are ranked with factors such as readmissions, mortality, safety of care, and patient satisfaction—all things that we believe that the communities that we serve should find important.

Within the Leapfrog reports, which give letter grades A through D, all AdventHealth hospitals in Seminole, Orange, Osceola, Valusia, and Lake counties have received an A grade for safety.

The world is changing, and every hospital and facility is also on this journey. So, the bar that you were able to meet this year for CMS star ratings or Leapfrog grades gets raised next year. Everybody needs to raise their game and these rankings give me the opportunity to look across my facilities and to see where we have opportunities to improve.

HealthLeaders: How are you focused on the issue of patient safety?

Finkler: We want to develop safe and reliable facilities across all avenues that our patients touch. We will know when we have reached success when we are all in a proactive system. We need to be able to identify future problems and be able to intervene now to prevent those future problems.

Improving safety involves empowering our entire workforce to speak up. I was trained in an era when the physician was the team. When I was trained, no one questioned what the physician had to say. That is not a safe environment.

We need to empower all members of the team to be able to speak up if they see something that does not look or sound right. Anybody on a team should be able to "stop the line." Even if you are the person who cleans the room, if you see something in that room that does not look right, you should be able to speak up. Everybody needs to understand the concerns of every member of the team. That is the way to achieve the safest possible environment.

HealthLeaders: What is your vision for leadership of AdventHealth's Central Florida Division?

Finkler: One of the advantages that I have is that our health system understands the importance of having chief medical officers at each one of the local facilities. These chief medical officers understand better than I do the issues in their local facility, and we communicate frequently. If there are any leadership issues, I can turn to my chief medical officers locally and we act as a dyad.

At the highest levels of this organization, the executive team realizes what the chief medical officers bring to the table. The chief medical officers understand that first and foremost we are a clinical organization that needs to deliver the highest quality care to the communities that we serve.

Given the fact that there is buy-in from every level of the organization, that is a great source of help for me. There has never been a time when the leadership has challenged or questioned what needs to get done to deliver high quality care. As a group, our physicians recognize that we are serious about what we are trying to do and that we are on a journey to become a top decile company because we want to be a leader in healthcare throughout the entire country. That is a journey that is going to take every one of us to make.

HealthLeaders: What are the key factors in physician engagement?

Finkler: The key factors are getting physicians to the table and having them be part of decisions. In general, physicians do not mind hearing "no." But when physicians hear a "no," they want to hear the why behind it.

I certainly believe in being completely transparent and putting physician leaders at the decision-making table. Several years ago, we started a group called the Catalyst. This is a group of physician leaders across our entire division, and there are now about 250 of them across our facilities. We have open discussions; we talk about the clinical goals that we want to attack in the next year. These physician leaders are part of the planning, development, and implementation of our strategies.

There is no better way to get physician buy-in than to have them be part of the plan. Part of including them in the plan is you must be completely transparent with your data.

You also need to celebrate wins. You start with easy wins because the easy wins will lead to more difficult wins. After a while, I will not need to lead the conversation. Physicians will come to me, they will recognize opportunities, and they will help us seize on opportunities.