Physicians at the Helm Q&A: Michael Cruz, MD, President of OSF Saint Francis

Cruz, an emergency medicine physician and president of a 609-bed hospital, says continuing to see patients weekly helps him "gain understanding outside of the patient interaction, about everything that is required to be in place to make that work successfully and effectively."

This is the first in an ongoing series of conversations with physicians who also lead hospitals, health systems, and other healthcare provider organizations.

When OSF HealthCare, the large nonprofit, faith-based system needed a new president for OSF Saint Francis Medical Center, its flagship hospital in Peoria, Illinois, leadership decided to appoint a physician for the first time in the hospital's history.

Michael Cruz, MD, rose from being a resident in the hospital's emergency medicine program in 1987 to hold various physician leadership positions, including associate chief medical officer and vice president of quality & safety, a position he began in 2007. OSF has nine hospitals, more than 600 employed physicians, home health sites, and two colleges of nursing.

He recently spoke with me about how his training as a physician helps him lead, and why he still sees patients.

HealthLeaders: OSF Saint Francis Medical Center is a 609-bed acute care facility with more than 900 clinical staff, why did you decide to continue seeing patients?

Cruz: I see patients in the ED once a week on Thursdays. I can't guarantee this will continue. It's tricky, but I was trained to be an emergency physician and I think seeing patients is important. The reason Thursday is interesting is because the medical students, rotating residents, and our residents don't work in the ED. That's their conference day. So we staff the ED quite differently on Thursdays, and as a result, I get to work in one of the busier areas seeing patients.

I do that for several reasons. I still want to maintain my skillset, and I enjoy seeing patients. When a conversation comes up [about clinical care], I can speak to it very clearly. When you live it and breathe it, you can bring a personal component to solving a problem.

For example, hospital administration might think something happens in a particular way. I can say, 'No, that's not how it happens, it really happens this way because I just did that last week.' It's one slice I can bring to this position as president that keeps clinical agenda fresh in my mind.

HLM: What factored into your decision to move into more administrative roles at OSF Saint Francis?

Cruz: It's been gradual. I've had some administrative positions within our emergency department group, which is a hospital group, so since 1990, I've had some administrative duties. Those duties, which were within quality and safety made it easy to transfer to hospital quality and safety work, which was an administrative position, in part. I was vice president of that position for 7 or 8 years, and spoke right to the CEO.

I've had a transition to this [leadership position] but there's still a quantum leap, I would say. I was trained to be a physician, not a president, or vice president, or administrator. There's been a lot of learning and growing. Sometimes I was a little shortsighted [as a physician], thinking,"I'll bring a fair amount to this administrative position," but really, it made me an even better physician.

HealthLeaders: How did being in an administrative position make you a better physician?

Cruz: I wish that physicians had more [leadership] opportunities because of what it brings to the bedside. You gain understanding outside of the patient interaction, about everything that is required to be in place to make that work successfully and effectively.

That understanding improves our ability to work within the group. In the emergency department, it may be a little easier because so many clinicians have to work in such a tight environment, and teamwork is a critical piece to that.

But I think understanding the bigger picture brings a lot of understanding to physicians as to why an electronic record works the way it does, why it is important to be integrated, and why it is important to do this or that before we do an admission or transfer a patient.

HealthLeaders: How can you deliver information about the broader strategy of OSF Saint Francis to physicians so that they aren't overwhelmed?

Cruz: The delivery of information can be inundating. Emails, texts, portals, departmental meetings, town hall meetings, that's how information gets across, but I think even more important than that is how do we engage clinicians in the same agenda? How closely in parallel can the clinicians work with the CFOs and the administrative team?

We have to engage the clinicians in administrative work. They don't all have to become administrators because we don't need 900 administrators. But the fact of the matter is that when there are decisions about the electronic health record system, how engaged are they? How engaged are they about modeling bundled payments, integrating care post-operatively for orthopedic patients, for example?

They [doctors] have to be an integral player in that movement. They have to understand how that is going to affect them in the long run. If they don't start having that language and hearing about it and playing with us in the sandbox together, then we're not going to be able to get where we need to be.

HealthLeaders: Now that you're at the helm what sorts of things are you doing or hope to put into place that bring the clinician closer to understanding the role they have in ensuring OSF Saint Francis achieves its goals of improved outcomes, quality, and cost?

Cruz: I think we're at the beginning. We look to benchmark and learn from other organizations. Our size makes it tricky. When you have 900, APNs, CRNAs, residency programs, etc. it's definitely a big change, but there's work around the graduate medical education and engaging the residents earlier on.

There's work within succession planning and talent management, performance improvement, and engaging physicians within dyad structures in certain service lines. Today, as opposed to 10 or 20 years ago, we have a lot more physicians that have formal training in patient safety, performance improvement, have gone through leadership academies, and from a physician standpoint, that's very different.

Going forward, we need to have them engaged at these levels of discussions so that when we have meaningful conversations about bed utilization and length of stay metrics, it's not just about what they see that day with a patient. It's about how that group of intensivists works with the residents and the APNs to affect change. That's how we're going to start moving that dot.