Rick Wright is relatively new to the position of CMO at Vanderbilt, but he is already full speed ahead on several department strategies.

In 2024, the top personal priority for the CMO of Vanderbilt University Medical Center is to continue to meet and interact with an increasingly broad number of people in the institution.

Rick Wright, MD, became CMO and senior vice president for clinical affairs at Vanderbilt in July 2023. Wright has been an executive at the health system since 2019, when he was named chair of the Department of Orthopaedic Surgery. Prior to joining Vanderbilt, he worked at Washington University School of Medicine in St. Louis, where he was executive vice chairman of the Department of Orthopaedic Surgery and director of the Orthopaedic Clinical Research Center.

Although Wright has been at Vanderbilt for about four years, he is focusing on getting to know people in the organization that he has not had a chance to meet because of the coronavirus pandemic and the relatively short time he has been CMO.

"I want to continue to become more comfortable with the areas of the institution that the CMO deals with that I have not dealt with as chair of orthopedic surgery," he says. "For example, there are aspects of the internal medicine and pediatric departments that I have not spent much time thinking about in the past. I want to expose myself to more of how they do business."

The effort to thoroughly acquaint himself with Vanderbilt leaders and key staff members is both organic and intentional, Wright says.

"On the organic side, I am getting to know people by working on projects and using that opportunity to get to know people better," he says. "For example, one of the general surgeons who is information technology savvy works under the adult ambulatory associate CMO. Over the past year, he and I had to work on an ambulatory project, so I have had several meetings with him, and we are now at the point where we are collaborating on other projects."

"On the intentional side, I am attending meetings that I previously was not a part of such as with ambulatory medical directors and executive medical directors for our patient care centers. I am singling out individuals in those groups that I have not previously worked with at both the adult hospitals and the children's hospital," he says. "The president and CEO of the health system has a weekly operational meeting, which includes about 30 leaders across the institution. I am making sure that I have a relationship with each of those people."

Institutional priorities

This year, Wright also is involved in supporting institutional priorities such as growth of clinical services and recruiting physicians.

Vanderbilt is building a new 180-bed patient tower at the health system's main campus in Nashville, Tennessee, as well as expanding services at three community hospitals acquired since 2019.

"We have some service lines that we want to augment as part of the increase in our bed capacity," Wright says. "This includes the Vanderbilt Heart and Vascular Institute. So, I am helping to recruit additional cardiologists, cardiothoracic surgeons, spine surgeons, and orthopedic surgeons. We are anticipating growth over the next three to five years to fill the new beds with specialty care that we think we are well-positioned to provide in the region."

Expanding services at the three recently acquired hospitals, including Vanderbilt Wilson County Hospital, is designed to address capacity constraints at the main campus in Nashville, Wright says.

"We are looking strategically at what services make sense to offer at these three hospitals," he says. "So, I am involved in making sure the appropriate services are covered and we are expanding other services in these hospitals. We have been working on recruiting gastrointestinal doctors, cardiologists, and surgeons such as orthopedic surgeons at the three hospitals to augment what they have been doing in the past."

Competition in physician recruitment is intense nationwide. To rise to the physician recruitment challenge, Wright says he is capitalizing on the strength of the Vanderbilt brand regionally and nationally.

"Physicians appreciate the chance to work here and to be affiliated with Vanderbilt," he says.

At the recently acquired hospitals, Vanderbilt has improved services and upgraded certain aspects of the hospitals, which has attracted physicians who are seeking more of a community practice while still working under the umbrella of the Vanderbilt health system, Wright says. In these physician recruitment efforts, Vanderbilt also has leveraged the opportunity for community hospital physicians to have access to world-class specialists at the main campus.

Photo: Rick Wright, MD, is CMO and senior vice president for clinical affairs at Vanderbilt Univesity Medical Center. Photo courtesy of Vanderbilt University Medical Center.

Wellness and well-being efforts at RUSH include a wellness office, wellness resources, and group and individualized coaching.

The wellness and well-being of staff members is among the top 2024 priorities of Paul Casey, MD, MBA, chief medical officer of RUSH University Medical Center.

Casey has been CMO of RUSH since June 2019. Before becoming CMO, he served in multiple roles at RUSH, including associate chief medical officer, senior patient safety officer, associate chief medical informatics officer, and chairperson for emergency department operations.

Staff members are a critically important asset and foundation for success, Casey says.

"They will always be our highest priority," he says. "When you take a step back, healthcare has been under assault over the past couple of years on multiple fronts not only related to the coronavirus pandemic but also with payers, dealing with inflationary pressures, and rising to the challenge of a tight labor market. The only way to successfully combat these challenges is to invest in our people and our teams, making sure they are empowered to help lead us forward."

Efforts at RUSH to address the wellness and well-being of staff members include having a wellness office and wellness resources, but the organization also reaches out to staff members through "listening campaigns" to understand the stressors that are impacting them, Casey says.

"We have done a lot of work to listen to the voices of our staff and to understand the biggest pain points and how we can help to resolve pain points whether it is workflows or other areas," he says.

One initiative that RUSH has launched to address physician burnout is helping to manage email, texts, and MyChart messages to clinicians from patients. RUSH physicians receive hundreds of these messages every week, Casey says.

"We make sure we have support for our physicians, so that only things that need to go to the physicians are escalated to the physicians," he says. "We also want to make sure that mundane tasks such as prescription refills are automated as much as possible through technology such as generative artificial intelligence."

RUSH has a robust coaching program in place to help promote staff member wellness and well-being, Casey says. There is group coaching to talk about how the organization views the challenges ahead and how staff members can deal with stressors. In addition, there is individualized coaching that is paired with the group sessions.

"The group coaching curriculum is focused on how we perceive some of the challenges in the workplace and different perspectives on how to deal with stress," he says. "The individualized coaching focuses on what individuals are facing whether it is work-life balance or how they are scheduling their time. We want our staff members to be scheduling their time to be as effective and efficient as possible. The individualized coaching also looks at how we are finding joy in our work life and our home life."

Paul Casey, MD, MBA, is chief medical officer of RUSH University Medical Center. Photo courtesy of RUSH University Medical Center.

Digital patient engagement

Another 2024 priority for Casey is supporting efforts to expand digital patient engagement at RUSH.

Like many other healthcare organizations, RUSH took a step back over the past couple of years to consider how the organization could provide more personalized and accessible care, Casey says, adding some of this effort has been related pressure from new entrants into healthcare such as Amazon.

RUSH recently rolled out personalized reminders for services such as screening and wellness visits.

"These are important things that we know are not often prioritized because of patients' busy lives," he says. "For example, we are connecting digitally through our primary care clinics to tell patients they are overdue for mammography screening and suggesting available times for that screening."

RUSH is also making it easier for patients to schedule appointments digitally, Casey says.

"We want patients to be able to make appointments with three clicks or less through our reminder system," he says. "We know that patients often get bogged down, and it quickly becomes more cumbersome to make appointments. We want to create a good experience in as few clicks as possible."

Supporting growth

This year, Casey also is involved in efforts to forge partnerships and grow ambulatory services.

"We are not only thinking about the ambulatory space in the traditional bricks-and-mortar sense of building new clinics and regional sites of care, even though that is part of our plan," he says. "What is going to be key to increasing accessibility for our patients is both the digital work we are doing and growth through partnerships. We are always looking at new opportunities to partner and expand our existing footprint, whether that is in the form of additional clinics or online presence."

Last month, RUSH opened a new rehab hospital in partnership with a large national rehab organization, Select Medical.

"We have found that our growth through partnerships is effective when we find the right partner that has the same goals in mind," Casey says. "Relatively quickly, we have been able to expand our services at the same level of quality that we expect because we are an organization that is recognized for the high quality of our care."

RUSH recently opened a new ambulatory care facility in the western Chicago suburb Hinsdale. "This is an expansion of our primary care as well as our first concierge offering," he says. "This is an example of how we are expanding our offerings for patients who want to access RUSH in different ways."

Advancing health equity

In the area of health equity, Casey and fellow executives are building on the work of a prior RUSH CMO, David Ansell.

"He was a pioneer in thinking about health equity long before it became an in-vogue topic for discussion," Casey says. "We have been focusing on our West Side of Chicago community in making sure we are sourcing both our opportunities to hire staff and our vendor agreements through our local economy to help lift the economy in the area. We are making an investment in the communities that we serve."

RUSH is also focused on providing equitable care, he says.

"We keep an eye on health equity quality metrics and how we are doing among different races and ethnicities to make sure we are providing equitable care," Casey says. "We look for trends that we can identify and correct. We have begun to do this work for all quality metrics to trend the data and understand where opportunities to improve health equity exist."

From a health equity perspective, the primary quality metrics RUSH is tracking include patient experience on both the inpatient side and the ambulatory side, hospital readmission rates, and mortality rates, he says.

The United States has the highest maternal mortality rate among high-income countries.

For chief medical officers seeking to boost maternal care, a top priority should be care coordination between the inpatient and outpatient settings, the CMO of Ob Hospitalist Group says.

The United States has the highest maternal mortality rate among high-income countries, according to statistics from the National Center for Health Statistics and the Organization for Economic Co-operation and Development. U.S. maternal mortality rates have been rising, with the rate pegged at 32.9 deaths per 100,000 live births in 2021, compared with a rate of 23.8 in 2020 and 20.1 in 2019, according to the Centers for Disease Control and Prevention.

CMOs should be focused on care coordination to achieve good maternal health outcomes, says Mark Simon, MD, CMO at Greenville, South Carolina-based Ob Hospitalist Group.

"Chief medical officers should focus on the continuum of obstetrical care from conception into the postpartum period," he says. "Especially at health systems, CMOs should be focused on how the outpatient setting is connecting to the inpatient experience that the patient has as well as care in the outpatient setting after the patient leaves the hospital. CMOs need to focus on how the outpatient setting and the inpatient setting are working together to ensure that the care is consistent across those locations. Good maternal care is about ensuring that connections are happening in the outpatient and inpatient settings, and those connections are happening consistently across a health system."

Good communication between care teams in the inpatient and outpatient settings is crucial, Simon says.

"Even if there is not a true admission, does the information that is gathered in the hospital setting such as an emergency room visit or an OB triage visit connect to the outpatient setting, where the patient is going to follow-up?" he says. "Is there a process by which that patient can have follow-up in a timely manner for whatever condition was seen in the hospital? Good communication is also required when patients are seen in the outpatient setting. Does the information that the patient has created during their visits in the prenatal experience get to the hospital? Does the physician and the team that is going to take care of the patient in the hospital know what has happened in the pregnancy before hospital admission? They should not be starting with a 'blank canvas.'"

In the hospital setting, care providers need to know where their patients are coming from and have relationships with community-based care providers, Simon says.

"Most patients we see at Ob Hospitalist Group have prenatal care to some extent," he says. "So, you must build relationships with the people providing the care, whether it is community physicians who are obstetricians, or it is midwives in the community. If hospitalists do not have relationships with these other care providers, it can create a very difficult situation."

Evidence-based care

CMOs should be involved in ensuring that maternal health patients receive evidence-based care, Simon says.

"There is evidence on clinical pathways and protocols that should be followed and adhered to," he says. "There are protocols on conditions that affect pregnancy. The key is to make sure those best practices are implemented in your clinical settings, whether they are outpatient settings or inpatient settings. With best practices, you need to implement them, you need to measure them, you need to analyze the data to see how you are performing, and you need to implement changes if things are not going as well as you want them to."

Simon says two key protocols in maternal health are a patient care bundle on hemorrhage and the management of hemorrhage in pregnancy as well as a protocol for hypertensive pregnancies. "Making sure patients are on the path with these protocols is the right thing to do because they can prevent poor outcomes," he says.

There are several maternal health metrics that CMOs should ensure are followed at health systems, hospitals, and outpatient clinics, Simon says.

• Mode of delivery such as C-section rate
   
• Hemorrhage metrics such as blood product use
   
• Hypertensive management such as how quickly anti-hypertensive medications are given to a patient after an abnormal blood pressure reading
   
• How quickly patients receive follow-up care for adverse conditions
   
• Screening for mental health disorders such as postpartum depression

Addressing workforce shortages

CMOs are well-positioned to address workforce shortages in maternal care such as a dearth of physician obstetricians, Simon says.

"What a CMO should be doing is thinking about how they are utilizing their obstetrical clinicians to the best of their ability," he says. "The CMO should be thinking about how they can have their physician obstetricians doing top-of-license work such as caring for high-risk patients and doing C-sections. These physicians should be involved in care pathways that require the highest level of medical support for patients. Then the CMO should be thinking about how they can supplement physician obstetricians with other clinicians such as certified nurse midwives and women's health nurse practitioners, who can manage the low- and moderate-risk patients."

CMOs should work on team building in maternal care, Simon says.

"If you think in siloes, with separate obstetrician practices and separate midwife practices, you will run out of clinicians," he says. "CMOs need to re-think how we do obstetrical care in this country. Most prenatal care does not need a physician obstetrician. Most prenatal care is relatively low risk or moderate risk, which is well-suited to the skill sets of certified nurse midwives or women's health nurse practitioners. CMOs should want physicians seeing high-risk patients or working in the hospital setting."

Shlomit Schaal is also focused on quality and patient safety as well as leadership development.

Shlomit Schaal, MD, PhD, MHCM, executive vice president and chief physician executive at Houston Methodist, has made physician well-being a top priority for 2024.

Schaal has three strategies for addressing the high-profile issues of physician burnout and well-being.

"We want to create a culture of wellness for physicians at Houston Methodist," she says. "We do not want a culture where physicians feel pressured to see as many patients as possible as fast as they can."

“The second thing we are focusing on for physician well-being is the efficiency of practice," she says. "There are many things in the modern practice of medicine that take up a physician's time, and we want to redesign our processes to make sure our physicians are practicing at the top of their licenses, and they have support to do things such as coding, billing, and answering messages."

"The third thing is personal resilience," Schaal adds. "We know there are ways that we can help physicians increase their personal resilience, which is related to a culture of wellness and efficiency of practice."

Schaal, who also serves as president and CEO of Houston Methodist Physician Organization, is leading a Joy in Medicine Initiative (JIMI) as well as reaching out to Houston Methodist physicians to see how they define a culture of wellness.

"I have to ask physicians, 'What does a culture of wellness mean for you?'" she says. "The idea behind JIMI is not to do a top-down assessment, then have me say, 'I think that a culture of wellness is defined by four elements, and here they are.' We are going to physicians and asking them about a culture of wellness."

Developing leaders

Schaal is also focused on leadership development this year.

Houston Methodist, which features an academic medical center and six community hospitals, has three leadership development programs: The Chair Academy, which serves the physician leaders who run the health system's clinical departments; the Administrator Academy, which mainly serves the administrative dyad leaders who are paired with clinical department chiefs; and a Physician Leadership Development Program.

"I truly believe that our leaders are the prime people who affect the efficiency, the morale, and the capabilities of their teams," Schaal says. "I want Houston Methodist to have the best leaders possible."

This year, the Chair Academy and the Administrator Academy are focused on three areas:

• Leadership: Program participants will find out about the key components of leadership, including the qualities of a good leader, how leaders influence people, and team building.
   
• Philanthropy: Program participants will learn about how to be well-versed in philanthropy to work with people who would like to donate to Houston Methodist or support an initiative that the health system believes is important. "Philanthropy is important because in medicine you need philanthropic help in order to go above and beyond for your patients," Schaal says.
   
• Communications: Program participants find out about how good leaders communicate verbally, inspire people through communication, communicate with a team, and relay bad news.

The Physician Leadership Development Program is taught collaboratively with Houston Methodist executives and Rice University professors. The program is designed for physician leaders who are not department chairs, and it lasts for six months.

It's basically a condensed version of an MBA program, Schaal says.

"We have several modules that physicians learn, including strategy, organizational behavior, finance, and operational management," she says.

Quality and patient safety

Schaal is also focused on advancing quality and patient safety.

"In my role as chief physician executive, quality and patient safety is part of my responsibility," she says. "We deliver high-quality care at Houston Methodist as measured by organizations such as U.S. News & World Report, the Centers for Medicare & Medicaid Services, Leapfrog, and Vizient. All of our hospitals are top performers in these external rankings. When I came here in April 2023, a big part of my role was to take quality and patient safety one step forward."

Last year, Schaal conducted a listening and learning tour of Houston Methodist facilities to see how the health system could improve quality and patient safety. During this tour, she learned that Houston Methodist did not have a communications strategy for quality and patient safety.

"We devised a communications strategy to communicate all the great things we are doing," she says. "Now, we have a website for quality and patient safety. We have a newsletter called Quality Time and a podcast called Quality Time. This is a way for us to share everything that we are doing with each other and with the world."

Schaal also found a lot of variation in how quality teams were built at Houston Methodist. So the health system devised a "diamond structure” at each facility, comprised of the CEO, chief quality officer, chief nursing officer, and quality director to lead quality efforts.

"In the diamond structure, all four of these executives work together to lead quality at their facility," she says. "This standardization has been helpful because we have also built communities around our CEOs, chief quality officers, quality directors, and CNOs. They can share knowledge with each other, with the spirit that a rising tide lifts all boats. If we share with each other, we can solve problems together rather than acting in siloes."

Schaal says the health system wants to "capitalize" on quality and patient safety academically, rather than financially.

"We want to highlight our process improvement efforts and all of our ideas and innovations at Houston Methodist at academic conferences," she says. "We want to share the success of our quality and patient safety efforts with our colleagues in Texas, the nation, and the world. We want people in other health systems to learn from us, so they can also improve."

Photo: Shlomit Schaal, MD, PhD, MHCM, is executive vice president and chief physician executive at Houston Methodist. Photo courtesy of Houston Methodist.