Physicians need to be able to trust the people who are leading them, chief clinical officer says.

Transparency and creating an environment that promotes autonomy, mastery, and purpose are essential in physician engagement, the chief clinical officer of Mercy Health-Lima says.

Matthew Owens, MD, chief clinical officer of Mercy Health-Lima, is a practicing physician specializing in physical medicine and rehabilitation. Mercy Health-Lima, part of Bon Secours Mercy Health, is anchored by St. Rita's Medical Center in Lima, Ohio.

HealthLeaders recently talked with Owens about a range of issues, including physician engagement, quality improvement initiatives, and patient experience. The following transcript of that conversation has been edited for clarity and brevity.

HealthLeaders: You have oversight of Mercy Health Physicians-Lima. What are the keys to success in supervising a physician group?

Matthew Owens: Leading a large medical group is an honor I do not take lightly. There are many pressures that our physicians and our advanced practice clinicians face every day while they are delivering care.

Maintaining an engaged clinician workforce is probably the most critical factor in achieving success in care delivery. If I do not have a workforce that is engaged in the work they are doing each day, it is difficult to do the work that the medical group is required to do.

HL: What are the primary elements of physician engagement?

Owens: Physicians are a highly motivated, competitive, and self-driven group of people. Most will perform at a high level if they are provided with the environment to allow them to excel. One of the most critical elements to physician engagement is transparency in leadership. Physicians need to be able to trust the people who are leading them. I try to be highly transparent—sometimes to a fault. I want to allow our physicians to feel engaged with the plans of the organization.

Beyond transparency and thinking about factors that promote strong engagement, I often refer to three major principles that I picked up from a book called Drive by Daniel Pink. In that book, Pink says people intrinsically want to do things that matter, and there are three principles that are important to allow people to shine. You need to grant them autonomy, mastery, and purpose. When I am thinking about leading physicians, if I can be transparent, then constantly work to give physicians an environment that promotes autonomy, mastery, and purpose, I know that the physician colleagues that I lead will perform at a high level.

HL: What are the primary challenges of serving as a chief clinical officer?

Owens: As we emerge from the stressors of the pandemic, I am struck by the pace of change and the pressures to manage that change. So much of what we do feels different than pre-pandemic.

We have an evolving set of challenges in healthcare. There are workforce shortages. There are mobility challenges in the workforce. There are inflationary pressures. There are regulatory burdens. And, frankly, there is a lot of gamesmanship among our nation's insurance providers. Those are all factors that immediately come to mind that impact the daily delivery of care to those that we serve.

HL: How are you rising to these challenges?

Owens: We are having to think about doing things in a different way than we used to in the past. We look toward different strategies for staff recruitment—it is not just the recruitment of physicians, it is the recruitment of the care teams surrounding physicians. Candidates are looking for something a little bit different than before the pandemic, and if we do not adapt to that then we are going to see ourselves falling behind. Once they are here, we must figure out what the key elements are to retain that workforce.

Healthcare organizations in this country are in a difficult spot. The inflationary pressures are certainly apparent as in any industry, but unfortunately reimbursement changes are not keeping up with the inflationary pressures. So, we must be wise about our expenses—we must manage those expenses tightly. 

Regarding regulatory burdens, there are a lot of new regulations being released on a regular basis, particularly during the pandemic. It has complicated our ability to be efficient with how we are using our workforce—we have a lot of pressures from various groups to try to live up to the standards they have set.

Matthew Owens, MD, chief clinical officer of Mercy Health-Lima. Photo courtesy of Bon Secours Mercy Health.

HL: What is Mercy Health-Lima doing to recruit and retain clinicians?

Owens: At Mercy Health-Lima, we are blessed to be leaders of a large, progressive regional referral center in a relatively rural area of Ohio. While that is not the setting that every physician seeks during a job search, we have a strong track record of retaining our physicians for a long time once they settle into practicing here. We are surrounded by several wonderful small cities and communities that are filled with wonderful people who seek our care, and that becomes endearing to our clinicians.

The landscape for recruitment is challenging right now. We know there is a physician shortage across the country. Our biggest sell is to convince clinicians to come and take a look at what we have to offer, to see how progressive our medical center is, then show them how nice it can be to live in our communities.

Regarding retention, we specifically work to ensure that our providers feel they have the tools needed to be successful. We also recognize the gravity of burnout and the emotional scar that the pandemic left on our care teams. We are healing together—we have developed a few methods of intervention that we hope provide members of our care teams a path to recovery. For example, we have a Life Matters platform that allows our providers to reach out if they have specific concerns related to mental health or burnout, or more broadly if they have specific life concerns and need help tracking down resources in the community.

We also have a program called Caring for Colleagues, where there are several of our physician colleagues across the ministry who have volunteered to provide their cell phone numbers so any care team member can call them at any hour of the day or night and receive counseling.

HL: What are the keys to success for quality improvement initiatives?

Owens: Transparency and communicating a clear "why" behind a quality improvement initiative are probably the most important factors to being successful. If I cannot communicate a compelling reason why a quality initiative should take priority in the minds of our care team members, it will certainly not gain traction.

HL: Give me an example of a quality initiative you have led.

Owens: As we emerged from the pandemic, we were finding that we had a high rate of catheter-associated urinary tract infections. That was partly related to long lengths of stay of COVID patients. We wanted to get those catheter-associated infections back under control. We brought together several physician and nursing leaders from across our healthcare market. We explained the "why" in a transparent way, and we asked them for action steps that would impact the hospitals that they lead. What was great as an outcome was getting buy-in right away, which helped us decrease those infections precipitously over the past six months.

HL: What are the keys to success in patient experience?

Owens: Our patients expect great care, and they are moved by how we make them feel. The soft skills of medicine such as body language and empathy are critical in every single patient interaction. As patients seek greater and greater awareness of their care plans, we must strive to keep them feeling like they are partners in their health.

The most basic thing is ensuring that our providers have the clinical skills and the knowledge base to be successful. That is the absolute baseline level that we would expect. The next level we would expect is the soft skills. I want a clinician in our market to walk into a room and not only make the patient feel they know what they are talking about but also make the patient feel like they are heard and they want to come back and see that provider again. That's how we convince our community that we are providing them a great patient experience. When patients leave feeling they have been heard and they have been truly cared for, and they leave thinking they want to come back, they go home and tell the rest of the community about that experience. Our providers also become more successful in attracting patients because of that experience.

So, we have programming that tries to teach soft skills to our providers. We try to go beyond the clinical knowledge base and make sure our providers are exposed to a curriculum that allows them to engage soft skills when they are interacting with patients.

Related: The Exec: WMCHealth CMO Renee Garrick Talks About Facing Current and Future Clinical Challenges

Mainly due to a shortage of primary care providers, millions of Americans do not have access to a usual source of primary care.

With more funding, Federally Qualified Health Centers would be well-suited to filling a gaping primary care gap, according to a recent report from the National Association of Community Health Centers (NACHC).

More than 100 million Americans do not have access to primary care, mainly due to a shortage of primary care providers in their community, the report says. The report deems these Americans as medically disenfranchised.

Federally Qualified Health Centers, also known as Community Health Centers, have a vital role to play in serving this medically disenfranchised population, Rachel Gonzales-Hanson, interim president and CEO of NACHC, said in a prepared statement. "The primary care gap is deepening in underserved communities across our nation, and Community Health Centers are vital to filling in those gaps by providing critical routine healthcare services. The COVID-19 pandemic only illuminated existing healthcare inequalities in the most vulnerable areas of our nation, making it crystal clear the important role of health centers."

The NACHC report highlights a national crisis, she said. "The Closing the Primary Care Gap report illustrates an unfortunate picture of medically underserved Americans with a disproportionately higher risk of harm from preventable diseases—and one-quarter of them are children. Expanding access to primary healthcare must be a national priority."

In addition to the findings that 100 million Americans do not have access to primary care and one-quarter of them are children, the report has several key findings:

• Only 11% of the medically disenfranchised population is uninsured, which indicates that lacking access to primary care is not mainly related to insurance.
   
• More than half of the medically disenfranchised population has an income below 200% of the Federal Poverty Level. These people may not be able to afford traveling long distances to access care.
   
• Without community health centers, 15 million more people would likely not have access to primary care.
   
• The number of medically disenfranchised people has doubled since 2014.

Investments are needed to reduce the medically disenfranchised population, the report says. "Access to primary care in medically disenfranchised communities can be improved through strategic investments, such as incentives for primary care practitioners to train and work in medically underserved communities and additional funding for Community Health Centers to expand their network of providers."

Addressing the shortage of primary care providers is crucial, the report says. "Gaps in primary care persist due to a nationwide primary care provider shortage that is driven by increased medical specialization and an uneven distribution of providers. Clinical trainees are pursuing increased specialization, which has led to a decline in the proportion of medical students and residents entering primary care. … Both primary care providers and specialists are more concentrated in highly populated urban areas that are home to higher-income, majority-insured populations. This pattern leaves fewer providers to care for rural communities that are more sparsely populated and may have a lower median household income. A variety of factors are also leading to consolidation, and clinic closures across the landscape of primary care practices are exacerbating the problem of unequal distribution."

More federal funding for Community Health Centers is needed to not only open more clinics but also to keep pace with inflation, the report says. "While the Community Health Center fund has increased by 14% since 2015, medical care inflation has risen by 25%, leading to a 9.3% decrease in federal health center funding in real terms."

Community Health Centers are geared toward providing services in underserved communities, the report says. "Health centers place an emphasis on culturally competent care and intentionally recruit providers who are underrepresented in the medical profession and those who reflect the cultural diversity of their community. This results in providers who represent the diverse racial, ethnic, and linguistic backgrounds of the communities they serve. Continued investments in these programs are necessary to sustainably grow the number of providers working in medically underserved communities and to strengthen the primary care workforce of the future."

Primary care is an essential component of the country's healthcare system, the report says. "Primary care providers can treat the common cold, ensure healthy childhood development, prevent future illness, manage chronic conditions, and connect patients to specialty services. Having a usual source of primary care is associated with decreased emergency department use and lower healthcare costs throughout the lifetime. On the other hand, a lack of access to primary care can weaken the public health response to future pandemics and could have dire consequences for patients, especially those facing compounding access barriers."

Community Health Centers should be part of the solution to the country's primary care crisis, the report says. "Health centers have a proven track record of filling primary care gaps in underserved communities, making them well-positioned to fill that need for the more than 100 million Americans who remain medically disenfranchised. The health center program has grown in the last five years to serve more patients and expand specialty services such as behavioral health, dental, and vision services in medically underserved communities. With sufficient resources, the health center program can expand into more underserved communities and continue to close the gap in primary care for America’s medically disenfranchised population."

Related: Poll Finds Consumers Embrace Virtual Primary Care

At Scripps Health, clinicians play an essential role in supply chain decision making.

Engaging clinicians is pivotal in healthcare supply chain such as value analysis and standardization initiatives, the top supply chain executive at Scripps Health says.

Cecile Hozouri, MBA, has been corporate vice president of supply chain at Scripps since 2010. She joined the San Diego-based health system as a supply chain manager in 2003.

HealthLeaders recently talked with Hozouri about a range of issues, including the keys to supply chain success, conducting value analysis for products, and enlisting clinicians in supply chain decision making. The following transcript of that conversation has been edited for clarity and brevity.

HealthLeaders: What are the primary elements of supply chain success?

Cecile Hozouri: First and foremost, you need an effective supply chain team. I have a very engaged team that helps solidify and support the supply chain across the organization and helps get changes done.

Another piece is a collaborative approach with clinicians. We are constantly connected with someone from the medical staff, the nursing teams, advanced practice nurses, or even our chief operating executives to have conversations about something we are thinking about doing.

At its best, supply chain is a vehicle for change. The Scripps executive team supports us in seeking change. All of our top executives are very supportive of moving forward with change. This is where the collaborative relationship with our clinicians is crucial. The only way we are going to achieve success with a change is if clinicians are doing it with us.

HL: What are the primary challenges of serving as corporate vice president of supply chain at Scripps?

Hozouri: For the past three years with the coronavirus pandemic, we have had significant challenges in the supply chain. That includes everything from raw materials, to specialty products, to the simplest plastic products such as syringes and basins. We have been able to tackle the most critical supply shortages by working directly with our nurses and clinicians who utilize these products and determine the best options for substitutions while their primary manufacturers are unable to produce the original products. It has been a challenging three years, and it continues to be challenging.

While we have managed those challenges with the supply disruptions and backorders, we are also combatting supply cost increases. We have had multiple conversations with our vendor partners to strategize what we can do together to offset those increases.

HL: How do you rise to the challenge of increased costs?

Hozouri: I have a very effective strategic sourcing team and contractual team that supports this piece. We have an integrated supply chain with our clinicians, which helps us manage costs. When it comes to cost increases, we are bringing those vendors to the table. When it comes to a physician-specific product, we make the physicians aware of what the cost increases look like, and they help us with that. They may choose another product.

HL: Do you work with a group purchasing organization?

Hozouri: We utilize a group purchasing organization called HealthTrust. They provide a wide variety of supply and service standardization opportunities for us. They have a full portfolio of commodity, service, and specialty product contracts that have been negotiated at great rates.

Cecile Hozouri, MBA, corporate vice president of supply chain, Scripps Health. Photo courtesy of Scripps Health.

HL: How do you conduct value analysis?

Hozouri: We have a clinical value analysis governance structure that is chaired by our physician leaders at Scripps. And within our own supply chain department, we have a clinical team that is made up of nurses with backgrounds in surgery, cardiac care, critical care, and med-surg. Our nurse team works closely with our service line leaders and connects with our nursing departments to review supply utilization data specific to their areas of expertise. Those reviews are centered on quality metrics and supply variation across our health system.

Our supply chain team also supports the clinical service lines in new product and technology requests, and they review how new requests may support our patient experience. Our collaboration with the clinical service lines is designed to choose the best products for the best patient outcomes at the best price possible.

HL: How is supply chain management organized at Scripps?

Hozouri: We have a very connected supply chain at Scripps. We have a corporate office function that has our contracting, procurement, and value analysis team. Then we have operations and logistics teams that work directly with our hospitals and clinics. Logistics supports all product and equipment needs for our standard processes such as ordering, receiving, and inventory management.

HL: How do you include clinicians in supply chain decision making?

Hozouri: Involving our clinicians is critical to our supply chain processes. On a daily basis, our logistics team or our nurses in value analysis work very closely with our service line physicians and nurses to address product disruptions. The physicians and the nurses review our recommended product substitutions if the manufacturers are unable to produce their usual products. We need their feedback to make sure that the substitutions can support patient care.

Clinicians also support us on cost-reduction initiatives, and clinicians review standardization efforts with our supply chain teams. For example, our emergency department clinicians came forward and asked about disposable devices that are used once and thrown away. We looked into that opportunity, and they were right—we were spending a lot of money on disposable products and there was a lot of waste. With their help and collaboration, we achieved more than $1 million in savings.

HL: How do you engage clinicians when there are supply disruptions?

Hozouri: We usually have physician leaders within the service lines that we connect with. We also have a physician executive at each one of our hospitals that provide other point persons for us to go to. Overall, when we are dealing with a supply disruption, we reach out to the physicians and nurses in that service line and talk with them about the backorders and the items we need to substitute. We pick up the phone. We send emails. We share product information. We send out substitute products that they can touch and feel to make sure things are OK to substitute.

HL: How do you convince clinicians to standardize supplies?

Hozouri: When we do standardization projects, we work with clinicians as a group. For example, when we come forward with standardization ideas in surgery, we bring those ideas to the surgeons as a group and see whether they are willing to take a look at changes. Getting the physicians to the table has not been a challenge for our supply chain team. We have been working very well together, and providing the necessary data to make decisions has been an effective way to get clinicians to the table.

Related: The Exec: 'Right Now, It Is About Supply Resiliency'

Accenture consultants present a framework for addressing health equity that has three core areas that every healthcare organization can embrace.

A new report from Accenture provides guidance on how healthcare organizations can address health equity.

Health equity has emerged as a pressing issue in U.S. healthcare during the coronavirus pandemic. In particular, there have been COVID-19 health disparities for many racial and ethnic groups that have been at higher risk of getting sick and experiencing relatively high mortality rates.

Healthcare organizations have an obligation to address health equity, a co-author of the Accenture report told HealthLeaders. "First and foremost, it is a moral imperative. If we were able to reduce the disparity in infant mortality, we could save the lives of thousands of Black infants. This is a justice and a moral imperative," says Ankoor Shah, MD, principal director of consulting and health equity lead at Accenture.

Addressing health equity is also a good business practice, he says. "There is a business growth and sustainability opportunity as well by advancing health equity. There is an opportunity to increase revenue and decrease costs; and those who are addressing health equity and reinventing themselves now will be a market leader in the future."

There are five causes of health inequities, according to the report: implicit bias, fear and lack of trust, access barriers, uneven quality and experience, and racism in research and development of clinical practices.

The report presents a framework for addressing health equity that has three core areas that every healthcare organization can embrace.

1. Mitigate bias in data analytics and algorithms

Clinical algorithms play an essential role in the digital systems at healthcare organizations; they are intended to boost accuracy and efficiency, but they have the potential to worsen healthcare disparities, the report says. "The most cited example is the large commercial health decision algorithm that used healthcare costs as a proxy for health needs, which inappropriately led to Black and African American patients being labeled as 'healthier' than equally sick white patients. To advance health equity, data analytics and algorithms must be inclusive, fair, accountable, transparent, and easily explainable."

Data analytics and algorithms can improve care, but they come with risks for health equity, Shah says. "If datasets have biases in them, then we could expand disparities. What that means is we often have incomplete datasets. If we do not have a dataset that has the true demographics for race, ethnicity, and language, then we purchase a third-party dataset to fill in those gaps, we run the risk of having a poor baseline dataset that we are applying analytics to, which can lead us astray and cause disparities to widen further."

2. Design inclusive products and services

Health equity should be a prominent factor from the beginning of product and service design, the report says. "Inclusive design methods enable and draw on the full spectrum of human diversity and individual experiences to create solutions. This does not mean that a single product or solution meets every person's needs. Instead, it means designing different ways for people to receive the same access, experience, and outcomes while having a sense of belonging. Considering health equity at this stage encourages better practices, greater accessibility, and a more inclusive healthcare environment, which drives value for people and ecosystem participants."

Focusing on inclusion builds patient trust in healthcare organizations, Shah says. "In our report, we mention that there are 7 of 10 Black Americans who say they are treated unfairly by the healthcare system. So, how can we reimagine healthcare's delivery to have trust? That is through an inclusive mindset—it is through an inclusive lens for how we develop products and how we deliver services."

3. Create sustainable structural change

Structural change is essential to make long-term progress in addressing health equity, the report says. "Racism and implicit biases are embedded throughout the ecosystem. Addressing institutional policies such as inclusive hiring practices, the types of partnerships created, and how participants execute clinical treatment and tools will have far-reaching effects on the sustainability of the healthcare ecosystem. Additionally, engraining equity as a core tenant of participants' foundation will aid in normalizing these activities across the ecosystem."

Shah cites the example of a health plan that tied executive compensation and incentives to reducing racial health disparities among its members. "What this does is uses structures we have in place to tie strategy to execution—to tie financial rewards to actually delivering what your business is intended to deliver and tie to health equity. You are changing the whole organizational mindset and the mechanics within it to drive advancing health equity."

Related: Institute for Healthcare Improvement Boosts Health Equity Efforts