Making a business case for hiring new infection preventionists starts with gathering data on the current state of infection rates and staffing concerns.
Infection preventionists have an expertise that is different from physicians and nurses.
They are trained in hospital epidemiology as well as sterilization and disinfection of reusable medical instruments, and they are valuable members of a CMO's clinical care staff.
An infection prevention and control executive at Boston Children's Hospital recently made a business case for hiring more infection preventionists and was able to gain approval to increase staffing by more than 50%.
"Infection preventionists add a lot of value," says Jennifer Ormsby, DNP, RN, senior director of infection prevention and control at Boston Children's Hospital. "They have an expertise that is very different from a nurse or a physician. They can improve patient safety and patient care."
Infection prevention and control programs at healthcare organizations are often understaffed, according to Ormsby.
"Nationally, infection prevention teams are understaffed," Ormsby says, "and the Association for Professionals in Infection Control and Epidemiology and infection preventionists across the country have been advocating post-COVID for C-Suite leaders to have more infection preventionists in their healthcare facilities."
At Boston Children's Hospital, there was a shortage of infection preventionists in ambulatory and procedural settings, and Ormsby led an effort to build a business case for increased staffing.
"Creating a solid business case to build your infection prevention program is key," Ormsby says, "especially when you are working with the C-Suite and advocating for additional resources."
Ormsby took a data-driven approach to building a business case for more infection preventionists. The process started with an assessment of the current state of the hospital's infection prevention and control program, including hospital-acquired infection rates as well as process measures such as hand hygiene, personal protective equipment audits, and the most recent accreditation survey results.
"I was able to present our current state, a bridge to the right size for our department, and right-sizing for our enterprise," Ormsby says.
Part of the business case was detailing overtime payments to the existing infection preventionist staff. According to Ormsby, the hospital was paying about $23,000 in overtime for the infection preventionist on-call staff member and $25,000 in overtime for contact tracing.
"My business case was sharing all the data, and the goal was to prevent infections and improve safety for our patients in procedural and ambulatory settings," Ormsby says. "If I didn't have the resources to be present in those locations to do observations and do quality improvement initiatives, I could not reduce infections."
Before presenting the business case, Ormsby had eight infection preventionists. After presenting the business case, she was able to hire four new infection preventionists and a manager of infection prevention.
Being fully staffed benefits the hospital and its patients because it allows the health system to help patients in all settings, according to Ormsby.
"Historically, the focus has been on inpatient settings as opposed to procedural and ambulatory settings," Ormsby said. "This is a challenge because more care is moving to the ambulatory setting such as day surgery. We need infection prevention staff members in those settings as well."
In addition to making a business case for more staff, there is a business case for limiting infections in healthcare settings, according to Ormsby.
"The business benefits of reducing infections for the organization include not getting reimbursement if an infection is identified as a hospital-acquired infection," Ormsby says. "Payers also can refuse to reimburse hospitals for surgical site infections."
Healthcare leaders should think about business value first in the face of AI’s allure, says Sutter Health’s Kiran Mysore.
Sutter Health’s AI leader says clinicians may be too optimistic about what the technology can do, and they need to understand that there are right and wrong ways to use AI.
“AI is very complex,” says Kiran Mysore, MS, chief data and analytics officer at the northern California health system and a participant in the HealthLeaders Mastermind program on AI in clinical care. “It is rarely a turn-key solution, where you adopt a model and expect it to work.”
“It needs a lot of good, clean data. It needs a lot of talented and skilled professionals to make it work the right way,” he says. “It needs the right workflow integration, and it should impact the point of care. And it needs to be trusted and dependable, which means you must tune the models well so they can predict the right answers.”
HealthLeaders is conducting its AI in Clinical Care Mastermind program through December. The program brings together nearly a dozen healthcare executives to discuss their AI strategies and offerings. As part of the program, each of the panelists are talking with HealthLeaders about the use of AI in clinical care.
Understanding the complexity of AI is one of six pieces of advice that Mysore offers for health systems embracing the technology in clinical care. The other five are:
You need to lead with the business problem or the clinical care problem you are trying to solve with AI first, before thinking about the technology. In some cases, the answer to the business problem may not even be AI.
In cases where AI is a solution to a problem, be very specific about the outcome you want to drive with AI. Focus on integrating AI into clinical workflows, measuring the outcomes over time, and understanding the improvements you are making against a baseline.
You should try to think about scale on Day 1. Don't wait until an AI pilot is done to think about the next step, because scaling takes a long time. If you don't think about scale and performance on Day 1, you lose momentum with your stakeholders.
Use best practices across the board and from the start. Talk with other healthcare organizations that have adopted AI models to learn from them, so you can capitalize on opportunities and avoid making mistakes.
The biggest pitfall is being too optimistic about AI. We are in the early days of AI initiatives. It is rarely going to work exactly as advertised because every use case in every health system is unique. You must think about challenging each promised AI capability. The pitfall is thinking that AI is a silver bullet, and that it will work for everyone.
Kiran Mysore, MS, is chief data and analytics officer at Sutter Health. Photo courtesy of Sutter Health.
How AI is impacting Sutter Health clinical care teams
Sutter Health has launched AI capabilities in ambient listening to summarize the conversations between clinicians and patients, suggesting responses to patient messages to clinicians’ electronic in-boxes, and helping radiologists work better with images.
"The opportunity is to educate clinical care teams about AI, the right use of AI, and the responsible use of AI," Mysore says. "We need to integrate AI into day-to-day workflows, whether it is a physician, a nurse, or hospital staff. When you do that well, you can see tremendous benefits."
"Ambient listening is saving our physicians valuable time every day in note taking and documentation," he says. "AI is helping with the cognitive burden on clinicians because they are feeling less stress at the end of the day because AI is helping them do things easily."
AI is also impacting clinical care teams in terms of augmentation, Mysore explains.
"I do not see clinical care teams going away because AI is taking over," he says. "What AI does is to make clinical care teams' jobs easier and it frees up time in their day to elevate patients’ experience. AI can help clinical care teams see more patients."
AI governance
Healthcare organizations often do not think about governance as much as they should in the early days of AI adoption, according to Mysore.
"We need to be transparent about what AI can do and cannot do," he says. "For example, if you are using an AI model that is trained on some patient data, we need to be transparent about what patient population was used to train that model. If the model was trained on a patient population that has different characteristics from where it is being used, then its outputs will not be reliable."
Sutter Health is evolving a comprehensive approach to AI governance, with a core AI governance committee comprised of legal and digital team members.
"On the legal side, the committee is focused on whether we are doing the right thing in terms of privacy, security, patient confidentiality, risk, and compliance," Mysore says. "The digital team is focused on whether we are using the right AI models, whether we are building the right technology infrastructure, and how these models are working."
The health system has participation from other groups in the AI governance mix, including a clinical group and a research group.
"We have a core group and sub-groups that are aligned to promote AI governance," Mysore says. "Depending on the need, these groups can engage each other on a frequent basis to get advice, get validation, and check on monitoring of AI models. The goal is to accelerate building the right AI capabilities."
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealtLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Physician recruitment and retention is a top issue for CMOs and other healthcare leaders, with the labor market for physicians extremely tight.
Bozek was appointed CMO at the hospital earlier this month. His prior leadership experience at Catholic Health includes serving as systems medical director overseeing the emergency departments at St. Catherine of Siena Hospital and St. Charles Hospital.
A generational change in physicians must be recognized in recruitment efforts, according to Bozek. CMOs need to make sure there is a good work-life balance for the workforce. Physician candidates need to know that leadership understands that family is important and outside-work activities are important.
"For my parents' generation, work came first, and family life came second," Bozek says. "This has shifted, where home life is coming first for many people."
To succeed in physician recruitment, you must have concise job descriptions, Bozek explains.
"If a physician does not know what they are getting into, they are not going to want to take the job," Bozek says. "On job boards and through your human resources department, you need to make sure the job description is clear."
A competitive compensation and benefit package is essential for physician recruitment and retention, according to Bozek.
"If you do not have that, then a physician will find another position that pays more or has better benefits," Bozek says. "So, you need to make sure you know your fair market value."
Strong employer branding is helpful in physician recruitment, Bozek explains.
"If you have a hospital that prides itself on orthopedic care or cardiac care, you should use that to your advantage," Bozek says. "Cite statistics, and say, 'This is why you want to work for us.'"
A streamlined hiring process can be pivotal, according to Bozek.
"Once you get a response from a job board, you want to respond back quickly and set up an interview," Bozek says. "You can set up a virtual interview, but it is even better to have a candidate interview in person, so they can see your facility and be more engaged."
Bozek recommends that CMOs let candidates know they are going to get back to them within two weeks after an interview. Within two weeks, the CMO should either offer the position or get any additional questions answered. Do not let the hiring process drag out because physicians will go elsewhere and find another job.
Additionally, onboarding programs need to be strong, efficient, and streamlined, Bozek explains.
"Onboarding at a hospital takes about three months," Bozek says. "You do not want hitches in the process that extend onboarding to five or six months because a physician might leave."
Physician retention is also multi-faceted and includes several aspects, according to Bozek.
"You need to make sure that physicians are engaged and happy as well as make sure that you are supporting them," Bozek says. "Their director should be supporting them with educational material and making sure physicians have the supplies they need."
Supporting physicians' educational needs is part of a good retention strategy, Bozek explains.
"You should give physicians opportunities for continuing medical education and taking courses," Bozek says. "You want to support physicians in staying up to date on medical knowledge."
Physicians are more likely to stay at a health system or hospital if they are recognized for doing good work, according to Bozek.
"As CMO, I need to be supportive and make sure when physicians are doing good things such as achieving high patient experience scores that I recognize their effort," Bozek says. "Sometimes, recognition comes in the form of monetary rewards and incentives."
Joshua Bozek, DO, is the new CMO of Catholic Health's St. Catherine of Siena Hospital. Photo courtesy of Catholic Health.
Supervising physicians
Bozek and hospital department chairs follow a process to supervise physicians and other clinicians. Every six months, the department chairs do a review of all the providers to make sure they are meeting all of the quality metrics that are within their department. If there are any outliers, that gets called to Bozek's attention.
"The providers have to stay credentialed with us," Bozek says. "So, there are routine evaluations by their department heads."
One of the most difficult responsibilities of a CMO is working with a clinician who is not achieving metrics or having challenges, according to Bozek.
"You need to be open and honest with them," Bozek says. "You want them to change their behavior and know what they are falling short on."
A CMO needs to have these discussions in real time—they can't try to address an outlier clinician six months after an issue arises, Bozek explains.
"Outlier physicians need to give me feedback," Bozek says, "to show that they understand what they are doing is either a problem or they are not meeting certain standards."
The InovaCare initiative features several elements, including enhancing connections with patients, generating a positive patient experience, and creating care pathways for clinical conditions.
Inova Health System has launched an ambitious initiative to transform how patients connect with the organization as well as establish care pathways for clinical conditions, according to John Moynihan, MD, president and chief of clinical enterprise at the health system.
Moynihan is also president of Inova Surgical Services, with oversight responsibilities for the service line across all five Inova hospitals. His prior leadership experience includes serving as chair of the Department of Surgery at Inova Fairfax Medical Campus.
One of Moynihan's top responsibilities is helping to implement the InovaCare initiative at Inova Health System, which Moynihan hopes will improve the ability of patients to access the health system.
"We want care to be more coordinated and more seamless for patients," Moynihan says. "By embracing evidence-based practice of medicine among our specialties and for particular clinical conditions, we believe that we can get outstanding results in our outcomes."
Improving patient experience is a key element of the InovaCare initiative, with an emphasis on the entire patient journey.
"First and foremost," Moynihan says, "we can never forget that in any encounter, we need to be able to have a patient receive our full attention and have the respect of whoever is caring for them."
To boost patient experience in the inpatient setting, Inova Health System has embraced "trio rounding," where the attending physician, the bedside nurse, and the patient round as a unit.
"It reinforces the confidence level that a patient has that his or her entire team understands the patient's goals and the decisions that will be made clinically," Moynihan says. "That makes sure the patient feels they are part of the conversation."
Listening to the patient is critical to improving patient experience, according to Moynihan.
"One of the questions we ask all of our patients is, 'what matters most to you?'" Moynihan says. "That makes the patient feel they are part of the decision-making process, and they can influence the direction of their care."
Respecting patients is essential to generating a positive patient experience in the inpatient and outpatient settings, Moynihan explains.
"We must respect the time that a patient commits to seeing us in the ambulatory setting, respect the schedule, and devote time to meeting with the patient face-to-face," Moynihan says. "Even if it is a telehealth visit, we want our providers to be focused on the patient's needs at the time of the visit."
The InovaCare initiative has multiple channels for communication with patients, and each patient can access the health system differently.
"For some patients, it may be an enhanced digital connection. For others, it might be a phone call," Moynihan says. "Some patients want to connect through email or texting. We must explore all of those options to meet our patients' needs."
Moynihan explains that seeking out patient opinions is another goal of the InovaCare initiative.
"A lot of what we do is going to need to include our patients' opinions to provide us with direction on how we improve the relationship with patients," Moynihan says. "The more we can understand the patients we serve today, the more successful we will be over the long term in designing efficient and patient-focused care models."
John Moynihan, MD, is president and chief of clinical enterprise at Inova Health System. Photo courtesy of Inova Health System.
Care pathways and care models
Establishing care pathways and care models for clinical conditions is a primary goal of the InovaCare initiative.
"We want to provide care that is evidence-based, and that will be dictated by the particular discipline that the patient is looking for care within," Moynihan says. "Whether it is back pain, heart failure, a breast condition, or lung nodule, each of those conditions will have evidence-based care models that allow for us to take care of the patient with evidence-based medicine."
Having care pathways and care models, which will be incorporated into the health system's electronic medical record, will reduce variation in clinical care. Moynihan hopes that standardizing care based on evidence and building care pathways into the electronic medical record will allow Inova to standardize care and measure the ability to deliver better outcomes.
"It has been well established that reducing variability in care achieves better outcomes," Moynihan says. "Reducing variability in care is also a more efficient way to care for patients."
To establish care pathways and care models, the health system brings together primary stakeholders at the start of the process.
"As we gather evidence that supports a particular pathway, we bring physicians, advanced practice providers, and nurses to the table and walk through what a care pathway might look like," Moynihan says. "We get their feedback, then come to a consensus about how we are going to execute a care pathway."
Crucial AI governance capabilities include understanding how AI tools are being used and monitoring of AI tools to reduce or eliminate unintended consequences.
Health systems should put a governance structure in place early in their AI adoption process, a top executive at Community Health Network says.
"You need to have the governance in place to make sure that you understand all of the tools that are being used, how the tools are being used, the intended outcome of usage, and how you mitigate bias," says Patrick McGill, MD, MBA, executive vice president and chief transformation officer of the Indianapolis-based health system. "Having a governance structure in place from the beginning is helpful."
HealthLeaders is conducting its AI in Clinical Care Mastermind program through December. The program brings together nearly a dozen healthcare executives to discuss their AI strategies and offerings. As part of the program, each of the panelists are talking with HealthLeaders about the use of AI in clinical care.
CHN recently hired a director of AI and data governance, who will be standing up an executive steering committee to help identify and prioritize AI tools and use cases.
The members of the executive steering committee will include McGill along with the health system's CFO, CMO, chief physician executive, chief information officer, and technical staff from IT and analytics.
"The focus of the executive steering committee will include prioritization of projects; implementation and use of policies, procedures, and traditional governing functions that must be put in place; resource allocation; and oversight of the monitoring of AI tools to reduce or eliminate bias and other unintended consequences of AI," McGill says.
Monitoring is a crucial AI governance function and varies based on various AI tools, McGill explains.
"Some of the monitoring will be through data reports," he says. "Some of the monitoring will be third-party partnerships to monitor the performance of an AI model. A third approach to monitoring will be to understand how third-party partners are using our data—we want to know whether data is de-identified, whether data is going out to a publicly available large language model, and what data the AI model is built on."
Prior to establishing the executive steering committee, the health system began the process of creating AI governance capabilities, according to McGill.
"We have put in policies, procedures, and guardrails for the appropriate use of AI," he says.
Patrick McGill, MD, MBA, is executive vice president and chief transformation officer at Community Health Network. Photo courtesy of Community Health Network.
Community Health Network's AI models
Like most health systems that have adopted AI tools, CHN is using ambient listening and ambient documentation to decrease administrative burden on clinicians.
"We partnered with DAX Copilot for the past year and a half, so we are using that technology across almost all of our outpatient specialties," McGill says. "It is helping people document faster and get out of the clinic faster. They can close their charts efficiently."
The health system recently adopted Secure GPT via a partnership with Qualified Health, which is HIPAA compliant. Clinicians can use the AI model to ask clinical questions and put in clinical information if they need to generate a letter.
"Clinicians are using it for note summarization and rapid look-up of clinical information such as the maximum dose of a certain medication," McGill says. "It is helping clinicians to get quick answers. Clinicians are using it for clinical workflows such as generating a consult letter or generating a summary—any information they might need to make the clinical workflow be more efficient."
One of the newer AI tools that CHN is adopting in a partnership with Notable, McGill says, will help streamline clinical workflows.
"For example, it will read a mammogram, identify whether the patient has an abnormality and needs additional imaging, and initiate a referral for the additional imaging," he says. "If the patient needs additional follow-up such as a breast MRI in six months, the AI tool will identify that need, then generate a referral for that follow-up."
Radiology is the focus for this AI tool now, but there are potentially other use cases with lab reports and procedure reports, McGill says.
Another new AI tool that the health system is piloting can conduct chart summarizations specific to a clinician—what the clinician's preferences are and what the clinician needs to know or wants to know before walking into a room to see a patient.
"This AI tool will automate a lot of manual work, and it is reading the chart to pull out nuggets of information that previously you had to have a human do," McGill says.
AI impact and advice
The health system's clinical care teams are giving positive feedback on the adoption of AI tools, according to McGill.
"AI is taking administrative work off their plate," he says. "It is removing administrative burden and allowing clinicians to focus more on taking care of patients. Often people are resistant to using new technology, but the feedback that we are getting on our AI tools has been welcoming."
In addition to establishing governance capabilities early in a health system's AI journey, McGill offers two pieces of advice to others who are adopting AI tools.
"One, you must include the clinicians in AI adoption from the beginning," he says. "Two, you must be willing to take chances. These tools are new, and they are not perfect, but they are only going to continue to get better. If you are only going to move forward with perfection, the train is going to go past you."
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
The Cincinnati-based health system's new chief clinical officer wants to create a culture of safety and stability.
The new chief clinical officer of UC Health is looking forward to helping the academic health system on its journey toward high reliability.
Arthur Pancioli, MD, assumed the role of senior vice president and chief clinical officer at UC Health in August. Prior to taking on his new position, he was chief transformation officer of the health system. He has a clinical background as an emergency medicine physician.
This year, UC Health launched an initiative to become a high reliability organization.
"Many healthcare organizations across the country have taken on the concept of high reliability," Pancioli says. "It is a well-studied science that is a methodology of improvement of an entire organization. We have just entered an engagement with a consultancy, and we are starting our journey to high reliability."
The first step in this process, he says, is assessment.
"The first thing you do is determine your current state and opportunities for improvement in high reliability, which is the pursuit of zero harm in a highly complex organization," Pancioli says.
"This will require that we truly see a culture shift and a mindset shift and a whole new way of doing things in this organization," he adds. "When we get it right, we can be what we aspire to be."
Pancioli says the most challenging part of this transformation will be enacting cultural change.
"You must create a culture of psychological safety, and you do that by defining the rules in ways that people understand," he says. "You highlight the behaviors you hope to see when they are modeled and demonstrated to set expectations. You also need to highlight behaviors that are not OK, and let the staff know how the organization will deal with them."
To establish a culture of psychological safety, a health system must shift away from a culture of blame and shame, Pancioli explains.
"An individual should not be blamed for an error unless it is volitional," he says. "Our people are doing complex things, and we need to address systems that set people up for the potential of errors."
Arthur Pancioli, MD, is senior vice president and chief clinical officer at UC Health. Photo courtesy of UC Health.
The health system's leadership team is playing a key role in the high reliability initiative.
"Like any major initiative, it requires abject buy-in from the leadership and a system where the behaviors that you hope percolate throughout the organization are modeled by the leadership," Pancioli says.
Frontline caregivers will also be crucial to implementing the initiative.
"You must engage frontline workers as subject matter experts and defer to them about the elements of the health system that need change," Pancioli says. "You can't do everything from the top down."
At health systems and hospitals, promoting high reliability requires an emphasis on patient safety.
"We have dedicated safety experts at every site of our organization," Pancioli says. "They are trained in avoiding potential harm to patients. They document near misses and see what we can learn."
"We have rigorous detection of errors, whether or not there is an impact on patients," he adds. "When there is an impact on patients from errors, that prompts a root cause analysis by a team using structured methodologies."
UC Health is working with healthcare technology company symplr to automate the adverse event reporting process. Staff are able to develop adverse event reports through the EHR platform.
"Because it is a standardized program specifically designed for this type of work, it leads us in information gathering," Pancioli says. "It starts a process to not only examine a singular event but also allows us to aggregate events and look for systemic causes of adverse events."
UC Health has "myriad triggers" for detecting medical errors and near misses, including staff reporting and patient complaints, according to Pancioli.
"For every reporting agency that we work with such as the Centers for Medicare & Medicaid Services, we have standard reporting of errors," Pancioli says.
With the AI landscape changing constantly, health systems need to watch their steps when applying the technology to clinical pathways.
Health systems should proceed cautiously in adopting AI tools, according to a top executive at UMass Memorial Health.
HealthLeaders is conducting its AI in Clinical Care Mastermind program through December. The program brings together nearly a dozen healthcare executives to discuss their AI strategies and offerings. As part of the program, each of the panelists are talking with HealthLeaders about the use of AI in clinical care.
The pace of change in AI is so fast that health systems must watch their steps as they adopt AI tools, says Eric Alper, MD, chief quality officer and chief clinical informatics officer at UMass Memorial.
"There are so many AI platforms that are being developed at this point that we must make good decisions about what platforms and models to implement," he says.
Healthcare leaders need to be smart about evaluation, and they need to understand where they are going to achieve the greatest value from AI, Alper says.
But first, he says, they need to establish a governance strategy.
"There is so much happening so fast in this space, including regulations, guidelines, and tools that are being released,” he says. “That is going to continue to evolve. So, you must have your set of experts lined up as more AI tools are released and there are changes in the environment."
UMass Memorial has established an AI governance committee specifically designed to help conduct the adoption and implementation of AI in clinical care.
"We are establishing a policy and a process for working through the different kinds of AI tools that are being requested at the organization," Alper says. "The AI governance committee will help us implement AI tools in the safest way."
The governance committee has several representatives from key areas at the health system, including clinicians, IT staff, legal team members, risk management staff, ethicists, and people who are focused on health equity.
"Choose wisely and do your due diligence," Alper says.
Eric Alper, MD, is chief quality officer and chief clinical informatics officer at UMass Memorial Health. Image courtesy of UMass Memorial Health.
UMass Memorial's AI tools
So far, the AI program that is having the biggest effect on clinical care teams at UMass Memorial is one that enables ambient listening documentation, according to Alper. At least 150 clinicians are using Nuance’s Dragon Ambient eXperience (DAX) tool.
During the clinician-patient encounter, the clinician first asks for the patient’s permission to use the tool, which is integrated into the Epic EHR. After the clinical encounter is done, the documentation note appears in the patient's chart within seconds.
"The people who are embracing DAX have been saying that it is transformative for them," Alper says. "They are finding it provides high-quality documentation with a lot less effort."
Another program, Alper says, uses AI for retina screening.
"We have been working with a company called AEYE Health," he says. "They are capturing retinal images of patients in the primary care setting, then they do AI image recognition to see whether there are any signs of diabetic retinopathy. If there are signs, a referral is made to an ophthalmologist."
UMass Memorial is also using AI in radiology, where the health system is working with Aidoc.
"They have put in place about 17 different models to look for findings on radiology images to try to identify those findings earlier as well as to help the radiologists to make sure they see critical findings that may come up," he says. "It helps us take care of patients more safely."
Beyond working with vendors, UMass Memorial is collaborating with the Massachusetts Institute of Technology to develop an AI tool that predicts hospital length of stay and monitors patient deterioration.
"Almost all of the AI that we are using has been developed by someone else," Alper says. "We are building on top of these AI tools and configuring them. The only AI tool that we have created within UMass Memorial has been the tool for predicting length of stay, which we are still developing and evaluating."
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs. To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Sentara Medical Group is planning to double the number of its APPs over the next three years, according to this CMO.
Advanced practice providers (APPs) are a critical part of the healthcare workforce since nurse practitioners and physician assistants can carry out responsibilities similar to physicians, including conducting physical exams, prescribing medications, and making referrals.
In the next decade, nurse practitioners and physician assistants will be among the top 10 fastest growing occupations in the country, according to the U.S. Bureau of Labor Statistics.
In part due to a need to increase care access, Sentara Medical Group is planning to double the number of its APPs over the next three years. Sentara Medical Group is the physician group of Sentara Health.
There are three reasons why Sentara Medical Group is seeking to double its number of APPs, says Steven Pearman, MD, vice president and CMO for primary care at the physician group.
"The primary driver of doubling the number of APPs is to increase access to care," Pearman says. "Another driver of increasing the number of our APPs is growth. We do pretty well with established-patient access, but getting new patients in is where the access challenge comes into play."
Finally, Sentara Medical Group is planning to utilize APPs to address a shortage of primary care physicians.
"There is high demand for primary care physicians but a decreasing supply," Pearman says. "We do pretty well in hiring, but it takes a lot of physicians to meet the increasing demand for care, and we can augment the ability of physicians to care for more patients by hiring APPs."
Relying on APPs in the primary care setting is a necessity, according to Pearman.
"In general, there is going to be an increased supply of APPs and there is going to be a declining supply of primary care physicians," Pearman says. "So, relying on APPs is a necessary step if we are going to provide care to the thousands of people who need primary care but do not have access."
Most of the new APPs will be deployed in primary care, where they will have their own patient panels, Pearman explains.
"One of the calculations is that if a primary care physician can take care of 1,500 unique patients, an APP can take care of 1,100 unique patients and two APPs can take care of 2,200 unique patients," Pearman says. "We can leverage APPs to increase our capacity."
Currently, about 50% of Sentara Medical Group's primary care providers are APPs, so there is about a 1-to-1 ratio of APPs to physicians. Pearman says the goal is to get to a 2-to-1 ratio.
Team-based primary care model
Sentara Medical Group is embracing a team-based model for primary care.
One of the goals of the team-based model is to take some duties away from physicians and APPs so they can spend more time on patient care delivery, according to Pearman. For example, the physician group is increasing staffing of a nurse advice line, and medical assistants and registered nurses will be fielding most electronic in-basket messages from patients.
"They want to see patients, but they are burdened by documentation, chart reviews, patient messages, and medication refills and renewals," Pearman says. "If we address those things, we can give physicians and APPs the cognitive capacity and time to take care of more patients."
Under the team-based model, primary care physicians and APPs have a collaborative relationship with defined expectations, Pearman explains.
"Early on in a relationship, even if the APP is experienced, there is close collaboration including physician chart reviews for about six months," Pearman says. "After that, there are select chart reviews."
Physicians serve as "sounding boards" for APPs, according to Pearman.
"We onboard APPs and educate APPs to manage complex issues," Pearman says. "If there is something they have not seen before or something they are unsure about, there is an open-door policy for APPs to go to their collaborating physician."
Another option for an APP is to refer a patient to specialty care, according to Pearman.
"We are rolling out electronic consults, which will provide APPs with an opportunity to ask questions before they refer a patient to specialty care," Pearman says. "APPs usually function as an autonomous primary care physician, with the backup of a physician if needed."
Addressing workplace violence is an important element of the CMO role at health systems and hospitals, this associate CMO says.
Addressing workplace violence is part of a CMO's responsibility to establish a positive work environment for clinical staff.
Healthcare organizations carry a heavy workplace violence burden, with about three-quarters of U.S. workplace assaults occurring in healthcare settings, according to the Occupational Safety and Health Administration. Workplace violence is prevalent in emergency departments—78% of emergency physicians have reported being targets of workplace violence in the prior 12 months.
Workplace violence prevention is an important part of running a hospital with a positive work environment, according to Maya Bunik, MD, associate CMO at Children's Hospital Colorado.
"It is part of making sure that we have a protected environment for our team members," Bunik says. "Addressing workplace violence boosts retention of team members, which is paramount."
Limiting workplace violence is an important part of her role, Bunik explains.
"We need team members to feel that when they come to work it is going to be a positive experience and that their service is going to be appreciated," Bunik says. "We want our team members to want to continue to work here."
Verbal abuse is the most common form of workplace violence in healthcare settings nationally and at Children's Hospital Colorado, according to Shelby Chapman, MA, director of patient-family experience at the hospital. Verbal escalation and verbal violence refers to behavior such as yelling, cursing, and using demeaning language.
In 2018, Children's Hospital Colorado surveyed its staff to see what kinds of workplace violence they were experiencing, according to Chapman.
"That survey in 2018 kicked off our journey toward addressing workplace violence," Chapman says. "It spurred our organization to make addressing workplace violence one of our pillar goals—one of the top-level goals that we focus on."
Workplace violence initiatives
One of the first workplace violence initiatives that the hospital launched was the creation of a safe and healing environment policy, which is promoted with flyers and signs throughout the institution, Chapman explains.
"It outlines the behaviors that we expect from our families and patients when they come into our facilities," Chapman says. "It also talks about how we are going to partner with families."
The safe and healing environment policy is helpful for having difficult discussions with families and patients about disruptive behavior, according to Chapman.
"It is also supportive of our families because when they are in an emotional or heated state, we don't want them to feel they are being singled out," Chapman says. "By having language accessible and on the walls, it helps our families know the expectations for everyone."
Bunik says that hospital leadership gets directly involved in workplace violence incidents, including a communication reconciliation initiative.
"An executive physician leader is on duty for a week at a time to support team members with difficult conversations," Bunik says, "whether it is a disgruntled family or a stressful situation that is hard for the team members to address."
Children's Hospital Colorado has two projects it has launched to address verbal escalation in the outpatient setting.
"Our scheduling teams and nursing teams were experiencing frequent verbal escalations, which was taking a toll," Chapman says.
The first project was a tip sheet to help team members deal with difficult families on the phone, according to Chapman.
"It is a one-page tip sheet on how to de-escalate an upset caller," Chapman says. "Although we have an annual training that goes through some of these techniques, the tip sheet is helpful because it can be hard to remember the techniques in the middle of a difficult phone call."
The tip sheet includes steps for team members to center themselves, advice on acknowledging a family member's emotion and empathizing with them, as well as tips to reach a resolution with a family member.
The other project for outpatient clinics was recording a patient's voice as part of the recording that greets callers, according to Chapman. The initiative originated from one of the hospital's clinics.
"Their idea was to record the voice of one of our patients and have that play at the beginning of a call," Chapman says, "as a way to turn down the temperature and remind the caller of what we are here for."
The hospital is also launching a video initiative to address workplace violence in the emergency department and urgent care center settings.
"In our emergency department and urgent care centers, it can be stressful for our patients and families as well as our team members," Chapman says. "We have recognized that one of the ways to prevent verbal escalation is to address common sources of frustration and to do some expectation setting."
One of the sources of frustration addressed in the video is the triage process. The video explains how the triage processes work and lets families know the care team will be getting to their child as soon as possible.
"In the emergency room, we see the sickest patients first, and that is the opposite of everywhere else you go in your life. Everywhere else, it's first come, first served," Chapman says. "When you are in the ED or urgent care with a sick child, triage can be frustrating."
Children’s Hospital Colorado has joined NRC Health’s workplace violence cohort. This cohort offers the hospital the opportunity to collaborate with other hospitals and health systems on tangible ways and best practices to create a culture of mutual respect and workplace safety.
Physician leadership development needs to be a top priority for health systems and hospitals as well as physicians who are interested in administrative roles, says this CMO.
Physician leadership development is pivotal for the U.S. healthcare system because many of the top-performing hospitals are physician-led.
Recent research shows there is a gap between physician interest in leadership development and opportunities to gain this experience.
A new report from Jackson Physician Search and the Medical Group Management Association found that 67% of physicians surveyed were interested in leadership development opportunities, but only 18% had been exposed to nonclinical leadership development through their education or experience in clinical practice.
It is essential for health systems and hospitals to offer leadership development opportunities, says Kristin Mascotti, MD, MS-HQSM, CPE, CMO of Penrose Hospital, which is part of CommonSpirit Health's Mountain Region.
"It is vital to provide physicians with leadership development opportunities," Mascotti says. "Some of the best-performing healthcare centers and hospitals in the nation are physician-led."
Leadership development is rarely provided in medical schools, according to Mascotti.
"In medical school, trainees believe themselves to be leaders, but they are so focused on clinical expertise that leadership development is rarely a focus," Mascotti says.
Similarly, early career physicians are focused on clinical expertise, and not on leadership development, Mascotti explains.
"When we look at what leadership roles physicians want to take, they want to either be leading within their department or serving on a committee related to their area of expertise," Mascotti says. "They want to lead in areas in which they are comfortable."
At CommonSpirit, there are formal and informal leadership development opportunities for early career and mid-career physicians who have shown influence in their department or on committees, according to Mascotti.
"We offer them a leadership training program, which can go up to a year," Mascotti says. "They develop expertise in leadership as well as finance, and they work on a project."
There are many committees for physicians to get involved in at the health system through the medical staff structure such as the Medical Executive Committee and Credentials Committee.
"It is a great way for physicians to become a part of committees and lead committees," Mascotti says. "We also have our medical staff involved in our Quality Committee, which is important in oversight of quality in the organization."
Finally, there are usually problems to solve in clinical departments, which can be a proving ground for aspiring physician leaders at CommonSpirit.
"These situations provide informal leadership roles that can evolve into formal leadership roles," Mascotti says. "Physicians can find a problem, solve it, then generate results such as lives saved, improved quality, and financial return on investment."
Beyond leadership development opportunities offered at health systems and hospitals, physicians can take the initiative to build their leadership skills. There are certifications for physicians such as a Certified Physician Executive, which is offered through the American Association for Physician Leadership.
"Physicians can benefit from leadership training programs that are six months to 18 months, depending on how quickly they can participate," Mascotti says. "That can then lead to master's degrees."
Physician leadership skills
When you look at the competencies of a great physician leader, the top two are influence and trust, according to Mascotti.
"To be a physician leader, you must have problem-solving and relationship-building skills in order to have great influence," Mascotti says. "You also need to engender trust. If you have those things, you can drive change in a team environment."
When looking at high-functioning teams, the number one capability of those teams is they have mutual trust and respect, Mascotti explains, which makes trust indispensable.
"Trust encompasses things like integrity, ethics, collaboration, and teamwork," Mascotti says. "If you look at engagement overall, it boils down to trust."
Additionally, Mascotti recommends that physicians who are interested in serving as CMOs seek out formal and informal leadership development opportunities to show that they can make an impact and influence others along strategic priorities.
"Most CMOs will require an advanced degree such as an MBA or MHA," Mascotti says. "I tell people who want to be a CMO to solve a problem and get involved in committees."
Mascotti, who served as CMO of NCH Healthcare System in Florida before joining CommonSpirit, pursued informal and formal leadership development opportunities along her path to becoming a CMO.
"First, I leaned into problems that needed to be solved in my department. From there, I had no dearth of projects to work on. The projects just got larger and larger," Mascotti says. "Then I got my Certified Physician Executive certification and went on to get my masters of science in healthcare quality and safety management degree."
Mascotti also recommends that aspiring CMOs get the Certified Physician Executive certification.
"You get exposed to things that you did not learn in medical school or early in your career," Mascotti says, "such as looking at your own emotional intelligence, finance, quality, and managing performance."
