Formal onboarding helps to ensure that new clinicians are successful in clinical practice, CMO says.
Onboarding is about more than helping clinicians navigate the hiring process.
According to the recently published Physician and Clinician Onboarding Research Report by the Association for Advancing Physician and Provider Recruitment (AAPPR), successful onboarding programs integrate clinicians into an organization, acquaint clinicians with an organization's culture, and provide clinicians with resources and support to help them excel in their new role. AAPPR compiled this data from a survey it conducted in collaboration with Jackson Physician Search and LocumTenens.com.
Providing effective clinician onboarding is pivotal in a health system's success, according to Pranav Mehta, MD, MBA, CMO of HCA Healthcare American and Atlantic Groups. HCA Healthcare, which features more than 180 hospitals, has more than 45,000 employed and affiliated physicians.
"It is critically important that we orient those physicians in a systematic way and approach," Mehta says. "We spend time onboarding them as they come from outside of our organization into our practices. That gives us the ability to make sure they are successful in clinical practice."
The AAPPR research report, which is based on survey data from 236 recruitment professionals and 1,550 clinicians, has several key findings:
Clinicians who had a positive onboarding experience reported being highly satisfied with their job 56% of the time, but clinicians who had a negative onboarding experience reported being highly satisfied with their job 19% of the time
89% of healthcare organizations reported having a formal onboarding process for all new clinicians
57% of clinicians reported receiving a formal onboarding process
32% of clinicians reported receiving an informal onboarding process
About 40% of survey respondents reported that their onboarding process ends within the first month, while about 40% reported that their onboarding process was three months to at least a year
The AAPPR report also found that clinician onboarding has four primary benefits for clinicians and their healthcare organizations.
Retention and job satisfaction: Effective onboarding programs boost job satisfaction and clinician retention. Onboarding helps clinicians feel more valued, increases their productivity and performance, and enhances their engagement.
Time to productivity: Onboarding accelerates the time it takes for new clinicians to start providing patient care.
Quality care and safety: Onboarding familiarizes clinicians with the policies, procedures, and systems that support quality care and safety. Onboarding also helps clinicians to understand and adhere to best practices, quality standards, and compliance requirements.
Culture: Onboarding acquaints clinicians with the values, mission, and culture of a healthcare organization, which boosts teamwork and a sense of belonging.
HCA Healthcare's onboarding model
HCA Healthcare provides both orientation and onboarding for clinicians, according to Mehta.
"When I think about the elements of orientation, they are time-bound and specific," Mehta says. "There are basic things clinicians need to know, which includes exposing them to issues related to HIPAA and the electronic health record."
The onboarding for clinicians includes training in leadership skills as well as leadership development, according to Mehta.
"We make sure they have exposure to the skills they need to succeed in a practice setting," Mehta says. "Onboarding is a little more detailed and granular than orientation—it is in depth and longer."
The onboarding process for clinicians at HCA Healthcare is conducted in the first year of employment. New clinicians are surveyed 90 days after hire to make sure the health system is capturing their voices and feedback, Mehta explains.
The best practices for onboarding at HCA Healthcare include having standard training, according to Mehta.
"No matter what state you are practicing in, we want clinicians to be exposed to some of the concepts around leadership, alignment, quality, patient safety, and other things they need to know to be successful in their jobs," Mehta says.
In terms of alignment, clinicians want to be connected to HCA Healthcare as an organization, Mehta says, which is bolstered by the surveys that are conducted with new clinicians 90 days after hire.
"Based on the feedback we receive, we can find out about the barriers physicians are experiencing in the inpatient and outpatient settings," Mehta says. "Then the executive team can work with clinicians at the local level, market level, and national level to mitigate barriers."
Mehta recommends focusing on a culture of safety as another clinician onboarding best practice.
"We want to make sure that clinicians feel they are part of a team that is committed to patient safety," Mehta says. "Ultimately, focusing on patient safety in onboarding results in better patient care and outcomes for us."
For clinicians, there is a strong correlation between a positive onboarding experience and job satisfaction, according to Mehta.
"It is a strong link, and it is a positive link," Mehta says. "What we are hearing from our clinicians is that they want an onboarding process that is effective, efficient, and meets their needs."
"Medspeak" is characterized as medical terminology used by clinicians that leads to communication gaps with patients. Medspeak gets in the way of effective shared decision-making for clinicians and patients.
There are several steps clinicians can take to make sure they communicate medical terminology and procedures effectively, and it's the CMO's job to make sure their clinicians are aware of medspeak and how to avoid it.
"The jargon, the abbreviations, and the terms we use in medicine seem natural to clinicians, but patients often do not understand these terms," says Donald Whiting, MD, CMO of Allegheny Health Network and president of Allegheny Clinic. "Clinicians can fly through an explanation without getting the patient engaged, then leave them behind."
Medspeak undermines shared decision-making, according to Whiting.
"If a patient does not understand the problem they are trying to solve, then they cannot make an informed decision," Whiting says. "If a patient does not understand the components of the problem and the decision process, then that gets in the way of shared decision-making."
There are three primary warning signs that medspeak is leading to a communication breakdown, Whiting explains.
"The warning signs include when you look into a patient's eyes, and they are not connecting," Whiting says. "Another warning sign is when you are having a conversation and you think you are explaining things, but the patient is just shaking their head. Another warning sign is when the patient is not asking questions."
Donald Whiting, MD, is CMO of Allegheny Health Network and president of Allegheny Clinic. Photo courtesy of Allegheny Health Network.
Avoiding medspeak
There are several steps clinicians can take to communicate medical terminology and procedures effectively with the 88% of U.S. adults who are not highly proficient in health literacy, Whiting says.
When patients come into a doctor's office, they are often nervous. Clinicians should make patients feel comfortable—greet them warmly, make eye contact, and listen to the patients' questions. Clinicians need to connect with their patients.
Once a clinician has connected with a patient, the clinician should use plain English to explain things rather than using jargon and terminology.
Clinicians should start a medical conversation with the basic components and make sure the patient understands the components. That involves speaking clearly, speaking slowly, and getting feedback from the patient.
Sometimes, a patient comes in with specific questions, but the patient and the clinician talk past each other. In these situations, the clinician should use the patient's questions in their own words to help address their concerns.
It is important to not rush through a discussion. The clinician should take the time to pause periodically and make sure the patient understands what has been said. The clinician should ask the patient questions to make sure they are understanding the content that is being explained to them.
Clinicians can use images and graphics to explain medical terminology or procedures.
A clinical encounter with a patient should be interactive conversation because the clinician and the patient can be clear that they are talking about the same thing and that they are on the same page. With a two-way conversation, the clinician can make sure what they are saying is comprehended by the patient.
For a clinician, the best metric to determine whether you are communicating effectively with your patient is when the patient asks relevant questions about what you are saying.
There are seven tips CMOs should teach their clinicians to communicate well during telehealth visits, according to the CMO of RWJBarnabas Health.
Telehealth visits increased exponentially during the coronavirus pandemic and remain well above pre-pandemic levels.
According to a study, the rate of telehealth visits among commercially insured U.S. adults increased from 0.3% of all healthcare encounters in March 2019 to 23.6% of encounters in June 2020.
A recent journal article, which was published by the Journal of the American Medical Association, gives four tips to help clinicians communicate well during telehealth visits, and Andy Anderson, MD, MBA, executive vice president and chief medical and quality officer at RWJBarnabas Health, provides three more.
With quality measure saturation in value-based contracts, many primary care physicians feel set up to fail.
Research conducted at the Providence health system shows primary care physicians are overwhelmed with quality measures in value-based contracts.
One of the primary criticisms of payers' value-based contracts is that there is little to no coordination of quality measures for which clinicians are held accountable. In addition, value-based contracts have been adopted for quality improvement in primary care despite mixed evidence of their positive impact.
A research letter published recently by JAMA Health Forum found that primary care providers at Providence have been saddled with an overwhelming number of quality measures in value-based contracts. The research features data collected from more than 800 primary care providers from 2020 to 2022.
The research letter includes the following key findings:
Value-based contracts contained a mean of 10.24 quality measures.
Primary care physicians faced a mean of 57.08 quality measures across 7.62 value-based contracts.
Medicare value-based contracts had more quality measures than commercial or Medicaid value-based contracts. The mean number of quality measures in Medicare value-based contracts increased from 13.14 in 2020 to 15.04 in 2022.
"Previous research on value-based contracts suggests these models have not lived up to their potential," the research letter's co-authors wrote. "We found saturation of the quality measure environment as a possible explanation: average physicians were incentivized to meet 57.08 different quality measures annually."
An overload of quality measures represents an unsustainable burden on primary care practices, according to the research letter's co-authors.
"Value-based contracting is intended to incentivize care improvement, but it is unlikely a clinician or practice can reasonably optimize against 50 or more measures at a time," the co-authors wrote.
Impact of quality measure saturation
The senior author of the research letter told HealthLeaders that the study's findings were unexpected.
"We were shocked by what we found," said Ari Robicsek, MD, chief analytics and research officer at Providence. "Effectively, the level of industry disorganization leads to a situation where individual physicians have way more quality metrics than they can possibly be expected to manage."
Robicsek compared the situation to the Olympic biathlon event, where competitors cross-country ski as fast as they can, then stop to try to hit targets with a rifle.
"Primary care physicians are expected to provide care to as many patients as they possibly can and deal with their patients' problems in the office," Robicsek said, "then all of a sudden, the physicians have to interrupt the flow of patient care to hit targets on quality metrics."
Most primary care practices are not configured to do both things simultaneously, according to Robicsek.
"It is disruptive, frustrating, and ultimately, when you have a large number of quality metrics, they become white noise," Robicsek said. "The quality metrics either become ignored or they create a sense for providers that they are set up to fail."
There are two ways to ensure that a primary care practice hits a target on a particular quality metric such as making sure patients are getting their breast cancer screening, Robicsek explained.
One way is to put the burden of the work on administrators, which requires hiring staff to look at lists of patients who have not yet received their breast cancer screening. Administrative staff will reach out to these patients, communicate back and forth with the patients if they have questions, place the screening orders, and follow up to make sure the screening was conducted.
"There is administrative cost to hitting a target on a quality metric this way," Robicsek said.
The other way is to expect primary care physicians to hit quality metric targets as part of their daily workflow. Under this system, when patients come in to see primary care physicians, the physicians must talk to the patients about quality metrics such as breast cancer screening or diabetes screening.
"The challenge is that primary care physicians are working with patients to address their problems in relatively short visits, then we are expecting them to fit in the administrative task of hitting quality metrics," Robicsek said.
Instead of expecting primary care physicians to remember to "close gaps" in quality measures, many practices have reminders in the electronic medical record (EMR) to prompt physicians to talk with their patients about quality metrics such as breast cancer screening. As the doctor is trying to go through their workflow and the patient wants to talk about a particular clinical problem, the EMR interrupts with quality metrics that need to be addressed.
"These alerts are interruptive, distracting, and can substantially affect the flow of a physician-patient encounter," Robicsek said.
Quality metric saturation contributes to physician burnout, according to Robicsek.
"If you feel set up to fail, and you feel that you can't do your job, that is going to contribute to feelings of moral distress and exhaustion," Robicsek said.
Reforming value-based contracts
Quality metrics in value-based contracts need to be redesigned so they are more manageable for physicians, according to Robicsek.
"There is no way that any physician is going to be able to manage 57 different quality metrics in their practice, while also trying to be a doctor," Robicsek said.
In principle, quality metrics that create incentives to provide great care are a good thing, but the current execution of quality metrics in value-based contracts is counterproductive, Robicsek explained.
"When they are done in a completely uncoordinated way such that a physician has way more metrics than can possibly be salient in their day-to-day practice," Robicsek said, "you do something worse than having no quality metrics at all."
The first step in the redesign process would be coordination among the different payers about what a limited set of quality metrics would be for use across the board for primary care physicians, according to Robicsek.
"Ideally, metrics would be chosen where there is an evidence base that demonstrates that incentives for metrics improve outcomes for patients," Robicsek said. "There also needs to be an evidence base suggesting that the set of metrics when used simultaneously benefits patients."
There are seven tips for CMOs to help clinicians communicate well during telehealth visits, according to the CMO of RWJBarnabas Health.
Telehealth visits increased exponentially during the coronavirus pandemic and remain well above pre-pandemic levels.
According to a study, the rate of telehealth visits among commercially insured U.S. adults increased from 0.3% of all healthcare encounters in March 2019 to 23.6% of encounters in June 2020.
A recent journal article, which was published by the Journal of the American Medical Association, gives four tips to help clinicians communicate well during telehealth visits, and Andy Anderson, MD, MBA, executive vice president and chief medical and quality officer at RWJBarnabas Health, provides three more.
1. Wait a second or two
According to the journal article, an experiment found that the time between one person speaking and another person speaking in a conversation increased from 135 milliseconds during in-person conversations to 487 milliseconds during video-based conversations.
"These findings suggest that during video telehealth encounters, clinicians should allow patients a second or two longer to respond to their questions than may feel natural," the journal article says.
It is often a good practice to give patients more time to respond to questions during telehealth visits, according to Anderson.
"If a patient seems hesitant or seems to need more time, that time should be given to the patient," Anderson says. "The clinician should go at a pace that the patient is comfortable with and give them time to respond to questions."
2. Start a telehealth visit with small talk
A clinician should ease into a telehealth visit with small talk, according to the journal article.
One study found that "friendly conversation" including small talk established a positive connection between pediatric cancer patients and oncologists.
"This argues for the utility of beginning a telehealth session with a small talk prompt, such as, 'How has your day been so far?'" the journal article says.
Starting a telehealth visit with small talk is helpful, just as it is in an in-person encounter, according to Anderson.
"Having a personal connection and having the patient start with talking about something that is easy to talk about warms them up," Anderson says. "It makes the telehealth visit feel more like a normal, in-person conversation."
3. Project a professional image
Selecting an appropriate virtual background such as an image of a doctor's office can help build credibility for a clinician during a telehealth visit, according to the journal article.
One online education study evaluated how students reacted to the virtual backgrounds of their instructors. The study found that personal virtual backgrounds were linked to a perception among male students that the instructor was less caring and trustworthy.
"Institutional or professional virtual backgrounds may help establish credibility," the journal article says.
Whether a clinician's background is virtual or real during a telehealth visit, it should be professional, according to Anderson.
"It can be an office or an examination room," Anderson says. "For example, the clinician should not be sitting in their living room with a television. As long as the background is professional, whether it is a real background or a virtual background with the name of the health system, either is OK."
4. Try to establish eye contact
Particularly for first-time telehealth patients, clinicians should look directly into the camera, and explain why they may have to divert their gaze for taking notes or completing other necessary tasks, according to the journal article.
Anderson also emphasized the importance of looking into the camera for clinicians who conduct telehealth visits.
"Ideally, you want to have good eye contact," Anderson says. "If you have to look away, you can tell the patient that you are going to write something down or look at the computer."
Other best practices
There are three other best practices for clinicians to optimize communication during telehealth visits, according to Anderson.
The telehealth visit should be treated just as an in-person visit would be treated in terms of some of the basics such as allowing the patient to talk and tell their story. Other basics include listening intently to the patient and giving the patient time to ask questions.
In terms of appearance and dress code, the clinician should dress professionally. Professional attire can boost the clinician's credibility.
Lastly, a clinician should ensure the patient is comfortable with the virtual visit technology in terms of how to use the camera, how to speak, and hearing the clinician. Cross-checking the technology is an important part of the visit to make sure it is working well for the patient.
"If you do not have the right clinical champion, I don't care if it is the best AI in the world, it will be dead on arrival."
When it comes to adoption of AI tools, health systems and hospitals need to be cautiously optimistic, says Doug King, MBA, senior vice president and chief information officer at Northwestern Medicine.
There is an enormous amount of hype surrounding AI in healthcare. Health systems and hospitals are adopting AI tools from partners or developing their own AI tools internally.
"You should be optimistic but realistic," King says of AI adoption. "There is a lot of hype around AI, so you need to understand what an AI tool is actually doing. You need to validate that an AI tool does what it claims to be doing. You need to trust but verify."
Northwestern Medicine has adopted several AI tools, and the health system is open to using any AI technology that is clinically relevant and that adds value to patients or clinicians, King explained.
"We are primarily focused on two key areas when we are evaluating AI," King says. "The first area is around early disease state detection, and the second area is around clinical efficiency."
AI tools that can achieve early disease state detection provide value for patients, according to King.
"If we can identify diseases through algorithms, such as looking at images or looking at radiology notes,” King says, “it is better for the patient because we can identify diseases earlier and intervene with care to keep them healthier."
AI tools that achieve clinical efficiency provide value for clinicians, according to King.
"We want to find AI that boosts provider efficiency because there are not enough doctors and not enough nurses,” King says, “so anything that we can do to make them more efficient so they can see more patients through AI is helpful.”
Northwestern Medicine has a robust process to evaluate AI tools that the health system might adopt, according to King.
"We have a team of engineers that understands AI," King says. "They validate the technology. They understand how the algorithm works. If we are working with an outside partner, we have technical calls with the partner's AI team to make sure that the algorithm works."
Clinicians also play a crucial role in the adoption of AI tools at the health system, according to King.
When adopting AI tools, Northwestern Medicine looks for clinical champions who understand the technology, who want to own the initiative, and who can drive the technology with other clinicians throughout the entire health system, according to King.
"If you do not have the right clinical champion, I don't care if it is the best AI in the world, it will be dead on arrival," King says.
When a health system or hospital is working with an outside partner, safety needs to be a primary concern in the adoption of AI tools, says David Atashroo, MD, CMO of Qventus.
"You have got to make sure that you are working with a partner that has a track record of building AI models and doing it in a manner that is safe and secure," Atashroo says. "That does not come overnight. It takes a lot of experience to do that well."
Health systems and hospitals should also be able to determine a return on investment from AI tools. According to Atashroo, an AI tool should be designed to address a specific problem.
"At the end of every problem, there is a potential outcome that can generate a return on investment," Atashroo says. "The only way you can validate and substantiate the benefit of an AI tool is insofar as it is deployed to solve an acute problem, where you can measure the impact on the back end and determine the financial return."
Patient-facing AI tools
One of the emerging areas for AI in healthcare are tools that are patient-facing, according to King.
"Patient-facing AI is just starting to come out," King says. "We will see it become more and more robust over the next few years. No. 1, AI will allow the patient to engage in the healthcare system the way they want to engage it."
Patient-facing AI will allow health systems and hospitals to personalize the patient experience, according to King. For example, if a health system knows that a patient has a preference to go to a particular location, a patient-facing AI tool will be able to automatically serve up times for appointments at that location.
"If the patient wants to have a dermatology check, we will be able to offer particular locations and times for that appointment using a patient-facing AI tool," King says. "It will allow us to personalize the patient experience as much as possible."
Northwestern Medicine is piloting a patient-facing AI tool that helps clinicians respond to messages from patients, according to King.
"If you send your physician a note, whether you have a question about something in your chart or a question about your prescriptions, AI reads that and generates an automatic draft response for the physician to use," King says. "That allows the physician on average to be about 30% more efficient as far as sending those notes out."
The health system is planning to roll out another patient-facing AI tool by the end of the year, according to King.
A patient will be able to start a conversation with a chatbot symptom checker. The symptom checker will ask the patient a series of questions, then the responses will lead to an understanding of the patient's clinical need, and the AI will point the patient to a physician who can address the clinical need. The AI will get the patient to the right place and look for appointments, so the patient can make an appointment without having to call an office.
"That is an entire interaction between the patient and the health system without any human interaction," King says. "It goes from what the patient is experiencing, what the patient is feeling, then making an appointment that works for the patient. It is going to be sophisticated."
AI tools are becoming more patient-facing because they are on-demand as soon as a patient needs access to them, according to Atashroo.
"As a patient, it can be frustrating when they need an answer to a question, but the clinician is not available or on call, so they have to wait," Atashroo says. "AI tools can provide immediate access when a patient needs it versus when a clinician is available."
The new CMO of Newark Beth Israel Medical Center plans to continue pursuit of high reliability that he helped lead at a Boston-based hospital.
Supporting the quest for high reliability in healthcare should be a top priority for CMOs, the new CMO of Newark Beth Israel Medical Center says.
Scott Schissel, MD, PhD, became CMO of the 665-bed academic medical center, which is operated by RWJBarnabas Health, this month. He had been CMO and vice president of medical affairs at Brigham and Women's Faulkner Hospital in Boston, where he also served as associate CMO and chief of medicine.
Pursuing high reliability is one of Schissels' primary strategies, which he honed in Boston.
"We had a system of just culture, where patient care was examined from the perspective of systems improvement and accountability that goes beyond individual human error," he says.
Staff from all disciplines at the Boston-based hospital shared a vision of high reliability and worked collaboratively on care and quality goals, Schissel says.
"In addition, every decision we made in healthcare leadership placed the patient's best interest and safety at the center," he says. "Creating and maintaining this kind of culture is hard work, and it is a continuous process."
The first principle of high reliability is transparency around safety and quality for the organization, so that everybody from frontline staff to the most senior leadership are willing to engage and talk about safety events and quality metrics, Schissel says.
"The dialogue that ensues is one of constructive building as opposed to a punitive or disciplinary environment," he says. "It's more about engaging in a culture of continuous process improvement."
A good example is process improvement in patient safety, Schissel says.
"At Newark Beth Israel Medical Center, there is an excellent electronic safety reporting platform, which is accessible for all employees," he says. "It is also important to have a culture where employees want to report safety events, and they are encouraged to report their observations. It should be celebrated when someone raises a safety concern."
The medical center has a Good Catch Award, where employees are recognized for reporting safety concerns, Schissel says.
"This kind of culture has led to a reduction in our serious safety events by about 80%," he says.
There are core elements to promote a culture of patient safety reporting, Schissel says.
"One is education of staff," he says. "Even at the point of onboarding, we train employees about our culture of safety, demonstrating that new employees know how to use the performance improvement tools and the safety reporting tool."
Maintaining that culture is also important, Schissel says.
"That has many avenues, from leadership rounding on the units to encourage and engage staff in reporting safety events to safety huddles on the units to a hospital leadership safety huddle," he says. "We are educating and reinforcing patient safety reporting on a daily basis."
Scott Schissel, MD, PhD, is CMO of Newark Beth Israel Medical Center. Photo courtesy of RWJBarnabas Health.
Promoting patient safety
The safety reporting system and safety culture at Newark Beth Israel Medical Center are foundational, Schissel says.
"Those are the most fundamental pieces of patient safety, so we can act on trends and individual safety events to make corrective action plans and process improvement," he says.
Promoting patient safety involves extending the work that has been done around safety reporting, Schissel says.
"When we receive a safety report, we are going to look hard at our response, which is through root cause analysis or interdisciplinary case review," he says. "We want to drill into how we methodically look at case events, so that when we make corrective actions, we are addressing the underlying root causes to minimize the recurrence of events."
The medical center's quality and safety teams look at all safety event reports daily, with supervision from Schissel and nursing leaders.
"We immediately engage the frontline unit where the event occurred, including their directors and staff, to obtain information," he says. "We review every safety event and plan different levels of root cause analyses, so that we address the underlying drivers of an event."
Best practices for promoting quality
Efforts to promote quality should be data-driven, Schissel says.
"The most important start to a quality program is to be sure you are dealing with the highest and best quality data of your clinical outcomes," he says.
Newark Beth Israel Medical Center has quality dashboards available to the staff that capture key metrics, such as hospital-acquired conditions and mortality, which are benchmarked against national standards, Schissel says.
"We are holding ourselves accountable to performance at a national level, not just our own year-to-year quality changes," he says. "We set clear goals to improve our quality metrics. Even if we are within the national benchmark, we always want to do better."
The medical center looks for opportunities for improvement in quality metrics no matter how well the hospital is performing, Schissel says.
"We have robust data around where our quality is doing well, on target, or falling short," he says. "We have a broad corrective action plan to address our performance."
"We look at core quality metrics every month," he adds. "We reassess where our interventions are working or not working like we want them to work. When needed, we institute new care protocols and care bundles. Like many hospitals, we can address conditions such as sepsis and heart failure by implementing care bundles or packages to enhance quality of care."
Part of providing quality care to patients with limited English proficiency is communicating with them in their own language, an AdventHealth CMO says.
CMOs need to ensure that health systems and hospitals have translation services for patients with limited English proficiency, the CMO of AdventHealth Apopka says.
In 2019, 67.8 million people in the United States spoke a language other than English in the home, according to the U.S. Census Bureau. Spanish was found to be the most common non-English language spoken in U.S. homes.
"Having translation services is critical to serve all patients consistently throughout the country," says Omayra Mansfield, MD, CMO of AdventHealth Apopka, an 158-bed hospital in Apopka, Fla., operated by AdventHealth.
"It should be a CMO's top priority to make sure we have the ability to communicate with our patients," Mansfield says. "Otherwise, you would never be able to deliver the type of care that we aspire to deliver."
A CMO should want patients to get high quality care like family members, and the ability to communicate is essential to attain quality, according to Mansfield.
"As a CMO, I care that my patients are treated like family," Mansfield says. "I can't imagine in a country like ours, which is so beautifully diverse, that we would have the ability to speak every language and every dialect just with the workforce that we have onsite."
AdventHealth Apopka's approach
Technology plays a role in how AdventHealth Apopka communicates with patients who have limited English proficiency. The hospital has contracted with a company that provides medical translation services virtually through video-enabled iPads capable of conducting three-way communication between clinicians, patients, and translators.
"We are able to navigate and identify what language the patient speaks—in particular what dialect," Mansfield says. "Then we connect with an interpreter so we can have communication with the patient in real time and in person."
By working with a translation service that specializes in medical communication, AdventHealth Apopka is ensuring that non-English speaking patients can understand medical terminology and care plans, according to Mansfield.
"We know the interpreter is capturing accurately what we are sharing and communicating to the patient," Mansfield says. "Similarly, we are getting the patient's responses, their questions, and their general understanding of the care plan as well."
For communicating with patients in general, and non-English speaking patients in particular, Mansfield uses the analogy of eating a pineapple, which is done in chunks rather than all at once.
"We need to provide small pieces of information—allowing the patient to digest those small pieces of information and ensuring understanding of information before we move on to the next chunk," Mansfield says.
Patience is also important when fostering clear communication with non-English speaking patients, according to Mansfield.
"We may have to take an additional step simply because of a language difference to be able to share information," Mansfield says. "Having patience is the only way we are going to give the care delivery we would want as if the patient was a loved one."
Another best practice for communicating with patients who have limited English proficiency is a process called teach back, Mansfield explains. After medical information has been shared with the patient, the translator is asked to prompt the patient to repeat back their understanding of what has been shared.
"That is one of the ways that we can adequately have confidence that our patients are understanding what we are sharing with them," Mansfield says. "If patients do not show an understanding of what we are sharing with them, we have to take the time to communicate in a different way to make sure they have understanding."
A longtime member of the HealthLeaders CMO Exchange discusses physician well-being, the evolution of advanced practice providers, and the impact of AI and technology on care delivery.
Denver Health CMO Connie Savor Price, MD, MBA, recently talked with HealthLeaders to preview some of the topics that will be discussed at this year's CMO Exchange.
The CMO Exchange is HealthLeaders' premier networking and peer-to-peer learning opportunity for CMOs, chief clinical officers, and chief physician executives. This year's event will be held from Sept. 18 to Sept. 20 at Miramar Beach, Fla.
In this podcast, Price, who is a longtime CMO Exchange member, highlights CMO Exchange discussion topics, including physician well-being, the evolving role of advanced practice providers (APPs), and the impact of technology and artificial intelligence on care delivery.
When it comes to physician well-being, it is important to realize that physicians are not averse to working long hours and tackling challenging situations, according to Price.
"What you need is a well-rounded work environment," she says.
There are several elements of a well-rounded work environment, according to Price.
You need to promote things outside of direct patient care
You need to address a good work-life balance
You need to provide mental health supports for some of the challenging situations
You need to reduce the chaos in work
You need to offload some of physicians' mundane tasks to others on the care team
You need to promote a sense of community in your work environment
Connie Savor Price, MD, MBA, is CMO of Denver Health. Photo courtesy of Denver Health.
The increasing number of APPs on care teams is a largely positive development, according to Price.
"They have become part of the team, and the idea is to expand access to healthcare when physician availability is limited," she says.
CMOs and other healthcare leaders need to be thoughtful in pairing physicians with APPs, according to Price.
"We need to address the best ways to partner physicians with APPs to ensure seamless care," she says. "One could argue that some of the diagnostic dilemmas might be best handled by physicians, while other more protocolized care might be the domain of APPs."
AI that does ambient listening during physician-patient encounters then produces high-quality clinical documentation is one of the most powerful applications of AI in healthcare so far, according to Price.
"This is something that physicians have long been wanting—to be able to have a conversation with a patient without having to worry about the details of the medical record and without having to worry about the details of billing and getting the words right in the medical record," she says. "Physicians have been looking for help in clearly communicating what happens in a patient care episode."
Decision support is another area where AI and technology are transforming care delivery, according to Price.
"It is something that helps us enhance our APP workforce," she says. "If you can combine some of those tools with the expertise of a physician and involve the APP workforce, you can get high quality care that meets the needs of a large number of patients with a relatively small workforce."
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A spike of antimicrobial resistant pathogens during the coronavirus pandemic does not bode well for the future.
The incidence of six bacterial antimicrobial-resistant hospital-onset infections increased in 2022 compared to 2019, according to a recent report from the Centers for Disease Control and Prevention (CDC).
The spike in antimicrobial resistant pathogens was likely caused by the impact of the coronavirus pandemic, according to the CDC. Drivers of the spike include longer lengths of stay, disruption of infection prevention practices, and increased inappropriate antibiotic use, the CDC says.
The increased incidence of antimicrobial resistant pathogens should be a top concern for CMOs, according to Anurag Malani, MD, medical director of hospital epidemiology, antimicrobial stewardship, and special pathogens at Trinity Health St. Joseph Mercy, which is part of Livonia, Michigan-based Trinity Health.
"CMOs should be concerned about antimicrobial resistant pathogens because patients who have these infections do not do as well as other patients," Malani says. "Their outcomes are not as good. They are more difficult to treat. They stay in the hospital longer. They incur more costs."
Additionally, an antimicrobial resistant infection in a patient can spread to other patients, which is a risk, he says, adding that these infections can increase mortality rates.
"There is a risk of dying from these infections," Malani says. "Ultimately, that is why CMOs should care about antimicrobial resistant pathogens."
The CDC report found increased incidence of the following antimicrobial-resistant hospital-onset infections during the pandemic:
Among the seven antimicrobial-resistant hospital-onset infections monitored by the CDC, only methicillin-resistant Staphylococcus aureus showed no sign of increasing during the pandemic. The incidence of Candida auris rose five-fold from 2019 to 2022.
Trinity Health St. Joseph Mercy has seen similar patterns with antimicrobial resistant pathogens as the CDC data, with several infections that have been difficult to treat in 2024, according to Malani.
"For example, Candida auris is a type of fungal infection that is very difficult to treat," Malani says. "Its prevalence in Michigan is much higher than it was pre-pandemic. It has become common in hospitals across Michigan."
Antimicrobial resistance can be hard to measure, according to Malani.
"It is hard to measure at a local site because you do not practice care in a vacuum," he says. "It is evolving, and it is impacted by other hospitals and health systems."
That is why data from the CDC and the agency's National Healthcare Safety Network is crucial for health systems and hospitals to understand the evolution of antimicrobial resistant pathogens, Malani says.
"We are going to be able to use this data in a region, in a state, and across health systems to help us in terms of surveillance," he says.
For health systems and hospitals, best practices for addressing antimicrobial resistant pathogens include having antimicrobial stewardship and infection prevention programs, according to Malani.
"Antimicrobial stewardship programs review patients, review whether patients have infections, determine whether patients are on the right antibiotics, and make sure patients are on the right duration of antibiotics," he says.
Hospitals have regulatory and accreditation standards around both antimicrobial stewardship and infection prevention, according to Malani.
"For example, if you are accredited by The Joint Commission, then you must have an antimicrobial stewardship program and an infection prevention program," he says.
The Centers for Medicare & Medicaid Services, which is the country's largest healthcare payer, also require hospitals to have antimicrobial stewardship and infection prevention programs, according to Malani.
Health systems and hospitals should also consider tying infection prevention and antimicrobial stewardship practices together.
"Across the continuum of care, we definitely need resources and expertise to do that," Malani says. "Many healthcare settings do not have that expertise. They don't necessarily have the funding, and they may not have the resources."
Looking to the future of antimicrobial resistant pathogens, there is cause for concern, according to Malani.
"Regarding my expectation for next year, antimicrobial resistance is here," he says. "We are going to have to figure out large-scale strategies to try to reduce the pressures on antimicrobial resistance. It could be more than how we use antibiotics."
Donald Whiting, MD, is CMO of Allegheny Health Network and president of Allegheny Clinic. Photo courtesy of Allegheny Health Network.
Connie Savor Price, MD, MBA, is CMO of Denver Health. Photo courtesy of Denver Health.