OU Health's chief physician executive must overcome a relative scarcity of physicians in Oklahoma.

The new chief physician executive of OU Health is focused on recruiting physicians and leading strategic clinical initiatives.

On Sept. 6, Cameron Mantor, MD, MHA, was named as chief physician executive at OU Health and president of OU Health Partners, which is the health system's physician practice. He had been serving in the roles on an interim basis since January. His prior leadership experience at the health system includes serving as associate chief physician executive for physician practice at OU Health Partners and CMO for OU Health's hospitals.

OU Health Partners is positioned for growth, and one of Mantor's primary responsibilities is to help manage the recruitment of new physicians.

Oklahoma ranks low for the number of physicians per capita in the country for almost every primary care area as well as specialties. So, OU Health and OU Health Partners face a challenge in terms of the number of physicians they employ.

One recruiting advantage for OU Health and OU Health Partners is the tripartite mission of the organization: education, research, and clinical care, according to Mantor.

"Our goal is to show physician recruits what we are looking to create, so they see what our vision is and hopefully that aligns with them," Mantor says. "That tends to attract recruits. We have a great academic health center, with seven colleges on our campus, so we can attract physician recruits both from an education standpoint and a research standpoint."

The health system's collaborative culture also draws physician recruits, Mantor explains.

"It is important that the physicians who work here work in concert with other physicians, other practices, and with all members of the staff," Mantor says. "We have a collegial environment."

Additionally, the health system provides a comprehensive compensation plan that provides physicians with the financial support that they need for themselves and their families, according to Mantor.

The compensation plan has several components. Base compensation is based on metrics linked to specialties. There is an academic component tied to a physician's department, which involves metrics including education, research, and clinical care. There are also incentive plans such as productivity incentive plans and quality and patient safety incentive plans, so physicians have opportunities to earn a bonus.

Cameron Mantor, MD, MHA, is chief physician executive at OU Health and president of OU Health Partners. Photo courtesy of OU Health.

Strategic clinical initiatives

As chief physician executive at OU Health, Mantor is involved in leading strategic clinical initiatives.

"For clinical programs, we think strategically about the expertise we have that we should provide to our patients, what are the programs that we do not have expertise in, but we feel our community needs, and the needs of our patients in general," Mantor says.

Pediatrics and trauma are two of the health system's primary strategic clinical focal points, according to Mantor.

"We have the state's largest, free-standing children's hospital, Oklahoma Children's Hospital OU Health, and children's healthcare is a huge focus for us," Mantor says. "We also are the state's only Level 1 trauma center for both adult and pediatric patients. Our ability to care for trauma patients who are severely injured is a strategic focus for us."

As a diverse academic system in adult practice and pediatric practice, OU Health is fortunate to have expertise in most specialties. If the health system determines it should launch a strategic clinical initiative in an area where it lacks expertise, physician recruitment is one method to rise to the challenge, according to Mantor.

"If we are unable to recruit expertise, then we partner with a local organization or across state lines," Mantor says.

Physician engagement is an essential element for strategic clinical initiatives, Mantor explains.

"The way we get to strategic clinical initiatives is not just the administrative team at the health system, which makes decisions about bricks and mortar as well as operations and finances, but also having physician leadership involved in decisions, which is paramount in making strategic clinical initiatives successful," Mantor says.

Inclusion is a guiding principle in involving physicians in strategic clinical initiatives, according to Mantor.

"From the very beginning, the discussions on the projects we are going to pursue include physician leaders," Mantor says. "We have a strategic governance team that is led by a senior physician and a senior administrator. Then we have broad representation, both from physician leaders and from administrative leaders. That core group will make decisions on major initiatives such as pediatric care and oncology."

Physicians are involved in the planning of strategic clinical initiatives, according to Mantor.

"If we are going to expand in the neurosciences or children's care or oncology care, once those decisions are made, we put the content experts from the clinical areas such as neurologists into the room," Mantor says. "They help us decide what the strategic initiatives should be and the tactics to move us along with a particular program."

CMO priorities

"At OU Health, the CMO's key roles are managing quality, patient safety, and patient experience," Mantor says.

Quality and patient safety go hand in hand, Mantor explains.

"In quality, as an organization we need to look at what is happening with our patients from a safety perspective or quality perspective that is putting them at risk," Mantor says. "We need to understand risk and be able to measure it. Once we understand what is happening, we must put processes in place to address preventable errors from happening."

Creating a just culture that promotes the reporting of patient safety events and near misses by staff is crucial for patient safety, according to Mantor.

"We want to know about potential issues that could cause harm," Mantor says. "If we want staff members to report, we must have a just culture. The reporting structure is not punitive. We want staff members to be able to tell us about issues so we can fix the problems."

For CMOs, there are several factors that contribute to promoting a good patient experience, Mantor explains.

"To generate a positive patient experience, we need to communicate with patients, explain to them what is going on, provide care options for them, explain the risks and benefits of care plans, and offer second opinions," Mantor says. "We need to provide good care and help patients to follow through on what they need to make themselves healthier."

An element of clinician engagement is giving them meaningful ways to influence a healthcare organization, a new CMO says.

To be successful in clinician engagement, healthcare organizations must give clinicians ways to influence the institution, says the new CMO of Medical City Denton and Medical City Argyle.

Glenn Hardesty, DO, was named CMO of the Denton, Texas hospital and its Argyle campus in August. He previously served as assistant CMO at Medical City Dallas.

Medical City Denton is an acute-care hospital and Level 2 trauma center that has 232 licensed beds; Medical City Argyle has 12 licensed beds. Both are part of Medical City Healthcare, a division of the HCA Healthcare health system.

Hardesty says clinician engagement is more of a philosophy than a series of interactions.

"Just because you have a medical staff golf tournament doesn't mean that you are engaging the physicians," Hardesty says. "You want to make sure that they have real input into the organization. You want to build structures so that they have meaningful ways to contribute to the health system and to make clinical decisions."

Medical City Healthcare has medical staff structures at each of its hospitals, according to Hardesty.

"How you utilize those structures can vary from facility to facility and health system to health system," he says. "We use the medical staff structures to hear the voice of the clinicians and to drive change. We also do an annual physician engagement survey to identify things that are top-of-mind among our physicians."

CMOs need to meet physicians where they are and actively listen, Hardesty explains.

"You don't want to pay lip service," he says. "You want to make sure that when physicians tell you something important, you take action when possible. If you can't take action, you need to tell the physicians why."

CMOs need to establish trust with their clinicians to engage them successfully, according to Hardesty.

"Without trust, engagement does not work," he says. "You build trust by experience over time. You can't come in on Day 1 and engage clinicians. It takes time to build trust. Trust is something that you must earn. You must have multiple encounters, and those encounters must be seen to have integrity."

Glenn Hardesty, DO, is CMO of Medical City Denton and Medical City Argyle. Photo courtesy of Medical City Healthcare.

Promoting quality care

There are two primary factors to promoting quality care in the hospital setting, according to Hardesty.

First, nursing is crucial to promoting quality.

"You must have nursing onboard in a quality plan and quality efforts to be successful," Hardesty says. "If you do not have the nurses on your side, if they do not have the bandwidth, if they do not have the understanding, your quality efforts are for naught."

The second factor is leadership visibility.

"Visibility as a leader goes a long way in promoting quality," Hardesty says. "When I left Medical City Dallas and came to Medical City Denton, the nurses gave me some advice. They said I was very visible, and I needed to keep that up, particularly with the nursing staff."

A major quality initiative that Hardesty helped lead at Medical City Dallas was limiting C. diff infections.

"With a quality initiative such as C. diff reduction, we found it takes everyone to be successful," Hardesty says. "It involved nursing and environmental services, for example. If the rooms are not cleaned properly, you can contaminate one patient to the next."

Part of the initiative involved targeting patients who were at high risk of infection.

"At Medical City Dallas, C. diff reduction was a challenge because there were specialized service lines such as bone marrow transplant that had high-risk patients," Hardesty says. "Those patients are extremely immunocompromised, and C. diff is easily passed in those kinds of units."

Key elements of the C. diff reduction initiative included training nurses on infection prevention, ensuring environmental service staff cleaned patient rooms effectively, and bolstering testing for C. diff.

"We wanted to know when C. diff tests were ordered and to make sure tests were ordered appropriately—that was a big part of what we did," Hardesty says. "We tested patients on arrival at the hospital if we suspected they had C. diff to identify patients early on, so those patients could be isolated and not expose other patients."

The C. diff reduction initiative generated positive results.

"When we started the initiative, we were having several cases per month at Medical City Dallas, and when I left the hospital, we were down to a small handful of cases per month," Hardesty says.

Risk management

In the hospital setting, risk exists everywhere, according to Hardesty.

"The key to risk management is to avoid engaging in unnecessary risk," Hardesty says. "You need to keep the preoccupation with failure front-and-center when dealing with risky situations."

Care teams should compare the alternatives before moving forward to avoid risk, Hardesty explains.

"For example, in the emergency department, you don't want to make moves until you are ready," he says. "You want to move appropriately and deliberately. You want to avoid rushing to judgment. You should pull back, use the resources you have at your disposal, make a decision as a team, then move forward."

Risk management and patient safety have a common theme, according to Hardesty.

"In risk management, you want to identify scenarios before they escalate," he says. "When it comes to mitigating risk, it helps to recognize risk early and address it sooner rather than later."

Clinicians should avoid using medical jargon when communicating with their patients, says this CMO.

For clinicians, communicating in a clear and understandable manner is crucial for providing quality care.

According to the Centers for Disease Control and Prevention, only 12% of U.S. adults are highly proficient in health literacy.

"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.