What’s more, the job descriptions have become more rigorous, says Christine Mackey-Ross, RN, a senior partner and co-practice leader at Witt/Kieffer. “Clinicians are in the thick of strategic decisions. They’re expected to not only bring a clinical voice to deciding what’s best for patients and practitioners, but they are expected to have the same business acumen as any other member of the leadership team.”
Clinician interest in pursuing an administrative track, rather than being thrust into it, is also becoming more common, Komnick says.
For Susan Distefano, RN, MSN, CEO of Children’s Memorial Hermann Hospital in Houston since 2011, executive ambitions were born out of her desire to answer what she calls ‘“somewhat naïve’” clinical questions.
“One of my guiding principles has always been to push myself to the next level of knowledge in anything I’m doing,” she says. So as a nurse, she became motivated to better understand the processes, costs, complexities, regulations, and innovations behind various approaches to care. “Once I answered the clinical and physiologic-based questions, there was always another level to dive into while working in a large infrastructure in a large system.”
In her current role, Distefano’s oversight focuses around the 310-staffed-bed tertiary and quaternary women’s and children’s facility, part of the 14-hospital Memorial Hermann health system serving Houston and the Southeast Texas community.
Her past experience at the bedside influences her leadership on a daily basis, she says. “It allows me to discern and identify which programs to really invest in and get excited about,” Distefano says.
A recent investment that made the cut, for example, was the hire of a surgeon with special expertise in reducing spasticity in children. Historically, children stricken by this condition, sometimes from birth, receive physical therapy, occupational therapy, and eventual surgery upon reaching school age, which yields only slight functional improvements, she explains.
“This surgeon trained under an expert where they take kids into surgery around two years of age, and the children are walking quite a bit and hitting some of their milestones almost effortlessly when compared to the late-surgery group,” she says. “Because I’m a clinician and I’ve seen that first group of patients and families struggle with incremental improvement, it was an easy investment in that physician.”
Thinking strictly as a businessperson, however, Distefano suspects she may not have recognized how substantially a single surgery could change lives or help her hospital make an imprint on the health of children in the community.
In the long run, the decision had two primary drivers of cost savings: A new neurosurgery intermediate care unit with specialized nurses allows many patients to receive the same level of neurosurgical care at a fraction of the cost of an ICU stay, she notes. In addition, Children’s Memorial Hermann Hospital has created a one-stop-shop called the Texas Comprehensive Spasticity Center, where patients can see their entire care team in a coordinated visit, streamlining the process for managing a child’s movement disorder while reducing the cost of care. Since it opened in 2014, the clinic has seen more than 200 patients and counting. Calculating those precise cost savings is difficult, though.
“While it’s impossible to precisely quantify the impact this decision has made on overall healthcare costs and utilizations for pediatric patients diagnosed with spasticity, the outcomes have been remarkable on improving our patients’ mobility,” Distefano says. “Some who once required a wheelchair for any mobility have not only been able to take their first steps, they are able to run around like any other child. This kind of functional independence saves tens of thousands of dollars a year in durable equipment like canes, crutches, and wheelchairs, and hundreds of thousands of dollars over a patient’s lifetime in numerous follow-up surgeries and procedures.”
Debra Shute is the Senior Physicians Editor for HealthLeaders Media.