Ardent Health's CMO shares how embracing technology is retaining physicians and nurses.
Health systems and hospitals have been grappling with high turnover rates for physicians and nurses since the beginning of the coronavirus pandemic in 2020. High turnover rates compromise access to care and have financial consequences for the bottom line.
Ardent Health has been focusing on technological approaches to addressing staff turnover at its hospitals and clinics.
"The turnover work that we try to do is clearly predicated on what we can do to improve workflows," says FJ Campbell, MD, CMO at Ardent. "Those are the most sustainable impacts that we can create."
To Campbell, the goal at Ardent with technology should be to improve workflows.
"We believe in the notion that good workflows lead to good clinical outcomes and lead to good financial outcomes," Campbell says. "As we consider the technologies that we leverage, it always gets back to how it is improving workflows."
Three factors related to cognitive burden are driving turnover at hospitals and clinics, according to Campbell.
"No. 1, it is the patient volume," Campbell says. "No. 2, it is the patient acuity—the severe illness that we are seeing in our hospitals. No. 3, it is the rigor around the documentation, which is increasingly about what we must do to support a bill or authorization versus using documentation for communication in the record."
Addressing nurse turnover
Virtual nursing has been the primary strategy to address nurse turnover at Ardent, Campbell explains.
"In one of our markets, we put telehealth technology in 400 rooms," Campbell says. "This allowed for a new breed of nurses—virtual nurses."
Virtual nurses at Ardent are rounding on patients, and completing intakes, admissions, and discharges, and they can come into the room at any time. The work that the virtual nurses are doing is cerebral, according to Campbell.
"They are usually seasoned nurses, and they are not getting interrupted," Campbell says. "That allows the nurses that are on-site to have a greater opportunity to handle complex tasks that are taking place, have a greater opportunity to be aware of the acuity of the patients in their panel, and have greater oversight of patient care technicians."
Virtual nursing is having a positive impact at Ardent, Campbell explains.
"Where we have virtual nursing, turnover has decreased sharply, and we have seen a reduction in the cost of care," Campbell says. "What is most important to us is we are trying to create a situation where nurses want to work for us and not leave."
Automated patient monitoring that helps to identify deteriorating patients is also addressing nurse turnover. According to Campbell, Ardent is partnering with FDA-approved BioIntelliSense, which provides a sensor that can be put on the patient to monitor things such as respiratory rate, heart rate, and body temperature.
"It is creating a situation where we can identify deteriorating patients up to 16 hours sooner than we could typically identify them with vital sign monitoring and telemetry," Campbell says.
As is the case with virtual nursing, automated patient monitoring has achieved positive results, according to Campbell.
"On the units where we have automated patient monitoring, we have seen a 15% reduction in mortality," Campbell says. "For the nurses in those hospitals, we have hospitals that are watching their back. They are less afraid to be at work. That impacts burnout."
Addressing physician turnover
In recent years, documentation burden has been a primary driver of physician turnover, Campbell explains.
"Electronic medical records have not been making significant inroads in reducing documentation burden, including the most advanced EMRs," Campbell says.
To rise to this challenge, Ardent has adopted Ambience, an artificial intelligence scribe tool.
"A clinician starts an encounter with a patient by saying the conversation is going to be recorded, then they have a conversation with the patient," Campbell says. "The clinician can look at the patient the whole time. The clinician then walks out of the room, and in less than a minute a clinical note is completed."
Ambience features the latest generation of AI scribe technology, according to Campbell.
"Early generations of AI scribes were good at dictation," Campbell says. "But the newest generations of AI scribes do a much better job of summarizing and linking to key elements that are going to communicate the acuity of the patient and affect the coding and the subtleties of what is in the clinical note overall."
Adoption of an AI scribe tool has revolutionized clinician and patient experience at Ardent. In one market where the organization is piloting Ambience, Campbell says not one of the 86 clinicians has dropped out, and patient satisfaction scores have gone up one full basis point on their scale of 1 to 10.
"It has improved coding," Campbell says. "Patients are commenting that the clinicians are talking with them directly the whole time of an encounter."
Virtual attending is another technological approach to addressing physician turnover at Ardent. There are clinicians such as cardiologists, neurologists, and nephrologists who are willing to truncate their practice so long as they can have access to patients through video encounters, according to Campbell.
"They do not go into clinics or hospitals any longer," Campbell says. "In many cases, they take a lesser level of compensation. They see patients for consultations via telemedicine."
Ardent has had video consultation for stroke patients for years, but the new virtual rounding strategy is different, according to Campbell.
"You don't have a cart come into the room as you would for a stroke patient," Campbell says. "This is seeing a patient in a setting such as the emergency department, where there is audio-visual equipment in every room. Clinicians can round on many patients virtually."
For physicians, virtual rounding reduces travel time and cognitive burden, Campbell explains.
"I have cardiologists who have been rounding on patients in certain hospitals, and they have not entered those hospitals for months," Campell says. "I have neurologists in our East Texas market who will never go into those hospitals. These are individuals who are basically moving beyond the traditional confines of having an office practice and going to hospitals for consultations."
Beebe Healthcare offers a residency program for physicians as well as financial support for clinicians to pursue advanced training such as master's degrees.
Beebe Healthcare has launched several workforce development programs for physicians and advanced practice providers (APPs).
Beebe has a robust team that recruits physicians and APPs, says Paul Sierzenski, MD, senior vice president and chief physician executive at the health system.
"We have a team that is working diligently so that when we have clinicians who have interest in joining us, they understand our vision, what we are looking to do for our communities, and know that we are here to help them be successful in their clinical careers," he says.
Beebe looks for physician and APP candidates who share the health system's goals and mission, according to Sierzenski. The goals of the health system's strategic plan include providing access to care, being best in core clinical competencies, being the employer and partner of choice, being patient-centric for all people, and being agile and sustainable.
Workforce development for physicians
Beebe is committed to the development of its physicians, Sierzenski explains.
"An important element is how we can further develop physicians, and that may be new physicians we recruit or as we grow physicians and help train them in our residency program," he says. "We are growing our undergraduate and graduate medical education program to help develop physicians for our communities."
Beebe launched a family medicine residency program two years ago and is planning to implement other residencies.
"We have four family medicine residents per year, with a goal to grow that number to as many as eight residents," Sierzenski says. "We are in our cap-building timeline, which means that in order to get funding from the federal government we have until June 30, 2028, to grow the program to six to eight residents."
The health system plans to launch an internal medicine residency with eight residents per year, as well as a transitional year residency that will bolster physicians' experience in specialties such as anesthesia and radiology.
There are several reasons why Beebe believes offering residency and fellowship programs is important for physician workforce development, according to Sierzenski.
"First, our family medicine residency is defined as a rural medicine residency, so we have more obstetrical experience for those physicians, and we are helping them understand how to connect with communities," he says.
"Second, we believe we should be providing advanced training in a couple of key areas,” Sierzenski says. “We are looking to establish a fellowship in palliative and hospice care, a fellowship in geriatrics because we have a growing retirement community, and a fellowship in sports medicine.”
"Third, even though we may not have fellowships that cascade off our internal medicine residency program, if folks are spending three years training and living in our community then pursue a fellowship outside of our community, there is a high likelihood that they will come back and work in the community where they trained as residents," he says.
Beebe encourages physicians to seek advanced training and pursue college degrees, Sierzenski explains.
"For our employed clinicians, we have a robust benefits package that includes support for individuals to go and get advanced training," he says. "We have partnerships with other organizations for advanced training such as a Master's degree in business."
Paul Sierzenski, MD, is senior vice president and chief physician executive at Beebe Healthcare. Photo courtesy of Beebe Healthcare.
Workforce development for APPs
Beebe has contracted with ThriveAP to offer advanced training to APPs, including nurse practitioners, physician assistants, and certified registered nurse anesthetists.
"We have a three-year agreement with ThriveAP, where we have an opportunity to give evidence-based specialty training to up to 10 advanced practitioners per year," Sierzenski says. "This is a way to help support those individuals in further learning specialty-specific domains and to drive up evidence-based care."
ThriveAP training includes acute care pediatrics, cardiology, critical care, emergency medicine, general oncology, family medicine, geriatrics, hospital medicine, pediatrics, mental health, urgent care, and women's health.
Leadership development efforts for physicians and APPs
Beebe also has a formal leadership development program for physicians and APPs.
"We have a clinical leadership development program that includes aspects related to conflict resolution, stress and time management, active listening, de-escalation, finance, budgeting, and accountability," Sierzenski says. "This program is open not only to our physicians but also our advanced practitioners. A personalized coach is part of the program."
Part of the clinical leadership development program involves working with executives from across the health system, according to Sierzenski.
"The individuals that go through this program interface with several departments in our organization such as the quality department to get a deeper understanding of how work is done," he says.
Effective ambulatory clinics have strong leaders and employ tools that bolster insights and decision-making, this chief physician executive says.
The first key to success in operating ambulatory clinics is selecting the right leaders, according to the new chief physician executive of Providence.
As of February, Susan Huang, MD, now serves as the chief physician executive at Providence and chief executive of Providence Clinical Network, which features 1,100 ambulatory clinics. Prior to taking on her new role, Huang served as CMO of the health system's South Division and CEO of the payer-provider Providence Health Network in California.
"In ambulatory clinics, you need to have the right leaders in place, so it is important to recruit the right type of talent," Huang says.
Providence has several programs to develop ambulatory clinic leaders internally, according to Huang.
"What we have found is that when we are able to grow our own leaders, they understand the Providence way, culture, and mission," Huang says. "That helps a lot with continuity."
The health system wants leaders of ambulatory clinics to have exposure to the broad environment of healthcare, Huang explains.
"We try to educate people on what is happening in the global context of healthcare, which is changing a lot," Huang says. "How healthcare was delivered in the past is not how healthcare is delivered now."
Changes in the delivery of healthcare over the years include an increase in administrative burden and a shift away from a paternalistic approach to the practice of medicine. For example, patients are more involved in their care now than in the past.
"The healthcare of the past was top-down. We knew what was best, and the patient was expected to follow," Huang says.
According to Huang, the advent of the electronic medical record was positive because health systems can now collect data in one place and extract information more readily.
"But at the same time, the EMR has created burdens in documentation, not just for physicians, but also for other staff," Huang says. "While we want to realize the potential of the electronic medical record, we also want to decrease the administrative burden that comes along with the EMR."
Successful ambulatory clinics also must have the right tools that lead to better insights and decision-making, Huang explains.
"You need tools that are timely," Huang says. "We have been aided by advancements in artificial intelligence's predictive abilities, including the ability to analyze large amounts of data, so that we can better understand our operations, populations, and the clinical care that we are delivering."
Susan Huang, MD, is chief physician executive at Providence and chief executive of Providence Clinical Network. Photo courtesy of Providence.
Succeeding in value-based care
Providence has posted positive results in value-based care.
"Looking at the program year for the Medicare Shared Savings Program in 2023, we generated more than $100 million in shared savings," Huang says.
Several factors dictate whether a health system can be successful in value-based care, according to Huang.
"There must be an alignment between the economic model and the clinical care and operational models," Huang says. "You need the right data and insights—you need to be able to make predictions and understand your populations."
Health systems must be aware of misaligned economic models in value-based care, Huang explains.
"With the flow of funds, they need to be aligned with the clinical activities we are expected to do. This includes incentive metrics for physicians," Huang says.
Clinicians play a significant role in delivering value-based care, according to Huang.
"They need to be attuned to evidence-based care, care pathways, best practices, and making sure there is a reduction in unwarranted variation in clinical practices," Huang says.
Providence helps clinicians to limit variation in clinical care. For example, the health system has embraced a decision-support tool called Clinpath in oncology.
"It is a tool that helps direct the chemotherapy regimens that a patient should be on based on factors including the type of tumor and pathology," Huang says. "We can establish the recommended chemotherapy and assess our compliance with evidence-based regimens."
Everyone in a health system must be involved in value-based care to achieve success, Huang explains.
"It is not just the physicians," Huang says. "It is not just the care managers. It is not just the hospitals or the clinics. Everyone must know they have a role to play in value-based care."
Flexibility and innovation are also essential in value-based care, according to Huang.
"You must be flexible, and you must innovate," Huang says. "You must think about new ways to engage your patients. This can involve technology such as remote patient monitoring to take care of a cohort of your patients."
Success in physician leadership
Providence provides opportunities for physicians to take on leadership roles.
"One of the keys to success in physician leadership roles is creating opportunities for physicians and advanced practice practitioners to understand what they could do in a leadership role," Huang says. "We also want to create a pipeline and a pathway for people to grow in their jobs."
At the health system, physicians can participate in committees and governance structures to experience leadership in different ways, according to Huang.
"Not everyone wants to take on leadership roles in the same way," Huang says. "Sometimes, it is taking a small bite of the apple, getting a little bit of exposure, and learning more about leadership."
Here's how AI tools are moving the needle in detecting colon cancer.
Artificial intelligence (AI) tools are improving the effectiveness of colonoscopies, according to the CMO of GI Alliance.
Colorectal cancer is the fourth most common form of cancer among men and women in the United States, according to the Centers for Disease Control and Prevention. It is the fourth leading cause of cancer deaths, the CDC says.
Colonoscopies are the most effective method to detect polyps in the colon that can progress into colon cancer, explains J. Casey Chapman, MD, CMO of GI Alliance, which features gastroenterology groups across the country.
"Colonoscopy is the best test we have—it is the gold standard for colorectal cancer screening as well as polyp detection," Chapman says. "There is nothing else that even comes close."
The main limitation for colonoscopies is related to the gastroenterologist workforce, according to Chapman.
"One of the limitations is that there are a lot of people who need an average-risk colonoscopy without enough people to do them," Chapman says.
With the shortage of gastroenterologists, it is imperative that colonoscopies are utilized appropriately and are done effectively, Chapman explains.
"No. 1, we have got to be sure that when we do a colonoscopy, it is sensitive to pick up polyps and colon cancer when they are present, and it is specific, meaning when colon cancer is there, we find it," Chapman says.
Polyp detection is crucial, according to Chapman.
"If you find a polyp, you want to make sure you bring that patient back for another colonoscopy at the correct interval," Chapman says. "If you don't find a polyp, you are very confident that the patient does not need to come back on a shortened interval."
J. Casey Chapman, MD, is CMO of GI Alliance. Photo courtesy of GI Alliance.
Adoption of AI tools
AI tools are making a difference in the detection of polyps in the colon, according to Chapman.
"AI has helped to start a bit of a renaissance of closing the gap for human error," Chapman says. "A gastroenterologist can miss a colon polyp. If that happens, there is an increased risk of interval colon cancer, which means you have cancer between the initial colonoscopy and the recommended second colonoscopy."
Several companies have developed computer-assisted devices that help detect colon polyps during a colonoscopy, Chapman explains.
"Basically, it is like having an extra set of eyes in the colonoscopy procedure to make sure there is fact-checking," Chapman says. "Where you see something, the AI will see it. Where you do not see something, the AI may show you there is something present."
The strength of AI in colonoscopies is going to progress as it teaches itself or as gastroenterologists teach the machine learning algorithms, according to Chapman.
"What we must do as human beings and the operator is make sure that what AI says is a colon polyp is a colon polyp, and it is getting better and better," Chapman says. "We also need to make sure when AI says there is no colon polyp there is actually no colon polyp. In other words, we still must make the ultimate decision, but AI does help to alert us that there could be danger."
The application of AI tools in colonoscopies is just beginning and exciting advances are on the horizon, Chapman explains.
"We are going to be able to utilize not only two-dimensional polyp detection as it exists today, but also move into three-dimensional spatial computing," Chapman says. "Not only are you going to see the polyp, but you are also going to be able to see it at a high image rate and in a three-dimensional fashion."
While AI has the potential to revolutionize colonoscopies, it is unlikely that AI will ever be able to conduct the procedure independently of a gastroenterologist, according to Chapman.
"The hard part would be patient buy-in. Patients probably would not want a machine doing their colonoscopy," Chapman says. "In addition, it takes about 10,000 colonoscopies to be really good at it because every colon is unique. If you are going to train AI to do colonoscopies, it is going to take hundreds of thousands of colonoscopies to train it."
Replacing the human touch in colonoscopies would be extremely difficult, Chapman explains.
"It is impossible to teach a machine trust and empathy," Chapman says. "When you are dealing with a person who might have colorectal cancer or colon polyps, the most important part of the entire process is the human-to-human relationship."
After screening for health-related social needs, health systems and hospitals can connect patients with community-based resources.
CMOs should be concerned that the health-related social needs of their patients are being met, according to a pair of experts.
Social determinants of health (SDOH) impact 80% of health outcomes, according to research. SDOH includes food insecurity, education level, transportation access, and economic standing.
There are several reasons why CMOs should be focused on making sure the health-related social needs of their patients are screened and addressed, according to Nebeyou Abebe, senior vice president of social determinants of health at Highmark, and Sally Kraft, MD, population health officer at Dartmouth Health.
"When people think about social determinants of health, they think about community programs and supplemental benefits. A third component that a lot of people do not pay attention to is medical cost reduction," Abebe says. "CMOs are tasked with medical cost reduction."
SDOH impacts patient engagement, Abebe explains.
"You need to be able to understand and identify when a patient has health-related social needs because they are a barrier for that individual from fully engaging in their care plan," Abebe says. "This is an opportunity for us to remove barriers to enable patients to fully engage in their health and well-being."
Regulatory compliance and payer contracts are related to screening and addressing SDOH, according to Kraft.
"Increasingly, we are seeing payers and regulators require screening for health-related social needs," Kraft says. "We can predict that soon there is going to be a requirement that you were able to meet your patients' identified health-related social needs. There are contracts that require that this work be done."
Addressing SDOH is also linked to the well-being of healthcare providers, Kraft explains.
"It is distressing professionally to have a patient before you and you cannot address the needs that are impacting their health," Kraft says. "Understanding social care needs and putting systems in place to respond to those needs will decrease the moral depression and moral injury that occurs for frontline staff."
Screening for SDOH
Screening for health-related social needs is the first step to addressing SDOH.
In 2019, Highmark and its health system, Allegheny Health Network (AHN), developed an evidence-based SDOH assessment tool for the payer's members and the health system's patients.
"We leveraged clinically validated screening questions to create a 13-question assessment covering social needs across several domains," Abebe says. "Through this assessment, we screen patients to identify their needs, then help to make connections to address these challenges."
There are several ways for AHN patients to complete the SDOH assessment, according to Abebe.
"The SDOH assessment may be completed through our AHN MyChart app before a visit, on a tablet in the waiting room, or a one-on-one interaction during an appointment," Abebe says. "We find that some patients enjoy the opportunity to complete the assessment on their own digitally, while others may not utilize technology the same way and may feel more at ease with someone asking them the questions."
Dartmouth Health started collecting information from patients about their health-related social needs in 2017, beginning in adult primary care clinics. The screening effort has since been implemented in other outpatient clinics and the inpatient setting.
At Dartmouth Health's outpatient clinics, which conducted 108,000 SDOH screens last year, patients complete the assessment tool through the health system's patient portal before an appointment or through a tablet when they come to a clinic.
"Patients' responses are secure, private, and voluntary," Kraft says.
In the inpatient setting at Dartmouth Health, SDOH screening is conducted by nurses or care managers.
"The care managers see patients to help organize care and understand whether there are needs that need to be met before the patient is discharged," Kraft says.
Addressing SDOH
Highmark and AHN use a community-support platform powered by findhelp to connect patients with community resources.
"The platform has a database of community-based organizations with resources that patients and members can access for free or at a reduced cost," Abebe says. "They can access resources such as food, housing, transportation, and utility assistance."
In addition, AHN has Healthy Food Centers and food prescription programs at six of the health system's 14 hospitals.
"A doctor can write a food script for the patient, and the patient can take the script to one of our Healthy Food Centers and access healthy food and additional resources to support both their food insecurity needs as well as their chronic condition needs," Abebe says.
Patients who have used the Healthy Food Centers have posted positive health outcomes, Abebe explains.
"Patients who have had a positive health outcome as it relates to our prescription food program include a drop in A1C of 1.28%, an average drop in body mass index of 2.04%, and an average drop in cholesterol of 44.7%," Abebe says.
In the inpatient setting at Dartmouth Health, care managers assist patients with making connections to resources in the communities where they live after they are discharged from the hospital.
"A resource that is used often is called 211, which is a centralized social care resource in New Hampshire," Kraft says.
In the outpatient setting at Dartmouth Health, such as primary care clinics, the health system employs community health workers and resource specialists to work with patients who have health-related social needs.
"They offer to meet with the patients to provide assistance with social needs," Kraft says. "They will meet with the patient, ask clarifying questions about the patient's social needs, then help patients identify goals, set goals, and meet those goals."
The community health workers and resource specialists try to equip patients with the skills necessary to address health-related social needs.
"The goal is to help patients meet their needs but not necessarily to do it for them," Kraft says. "We coach patients and help them learn problem-solving skills."
These community health workers are having an impact.
“In our most recent report, where we provided information on how well we did in 2024, we found that for community health workers that were working with patients and started an action plan to meet social needs, about 72% were completed," Kraft says.
Essential elements of physician leadership include listening skills, goal setting, the ability to make outcomes better, and providing good feedback, according to this CMO.
Physician leaders play a crucial role in the success of health systems and hospitals. They occupy key positions, including work as CMOs, department chiefs, and service line leaders.
RWJBarnabas Health takes an intentional approach to physician leadership development. Physician leaders have several essential qualities and characteristics, according to Andy Anderson, MD, MBA, CMO and chief quality officer at RWJBarnabas.
"Good physician leaders are excellent listeners, and they understand the key issues that their stakeholders are going through, including their physician colleagues, nurse colleagues, patients, and families," Anderson says. "They are listening, and they understand what the issues are and think about how they can make improvements."
A good physician leader tries to make outcomes better for patients and families as well as for their colleagues who work with them in health systems and hospitals, Anderson explains.
Effective physician leaders also are adept at goal setting in critical areas such as safety, quality, and patient experience, according to Anderson. They must be able to hold others accountable to achieve goals.
"They need to be able to influence their colleagues who work with them in health systems and hospitals to generate good outcomes," Anderson says. "Part of that is using data to demonstrate baseline performance and to track progress."
Strong physician leaders must also be able to get good feedback and provide guidance to help their physician colleagues improve performance at the frontlines, Anderson explains.
[SUBHED] Identifying physician leaders
RWJBarnabas energizes physicians to step up and self-select for leadership roles, according to Anderson.
"When a physician is interested in leadership, we would love to hear from them and encourage them," Anderson says.
The health system also monitors physicians to see how they behave in meetings and how they interact with their colleagues to identify future physician leaders, Anderson explains.
"When physicians show leadership potential, we ask them whether they are interested in taking on additional responsibility," Anderson says. "That can be progressive responsibility in terms of leading a committee or leading a particular initiative, then it can progress to leading a department or program."
Andy Anderson, MD, MBA, is CMO and chief quality officer at RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.
Physician leadership development efforts
RWJBarnabas has several physician leadership development efforts in place.
The most formal physician leadership development program, which was developed by senior leadership including Anderson, is an all-day session designed to impart leadership skills for emerging physician leaders.
"We walk through things such as what does physician leadership look like—what are the behaviors physician leaders exhibit," Anderson says. "We talk about areas such as recruitment, performance management, how to give effective feedback, how to maintain wellness for yourself and your colleagues, and change management."
Mentoring and coaching are essential elements of physician leadership development at RWJBarnabas, Anderson explains.
"It is important for senior physician leaders to be great mentors, great coaches, and great role models," Anderson says, "so others can observe the things we do and in turn do those things themselves."
A crucial element of mentoring and coaching physicians who aspire to being leaders is giving good feedback.
"A coach or mentor must understand a physician leadership candidate's strengths and weaknesses," Anderson says. "If there are behaviors that are not the right behaviors, a coach or mentor should make sure that feedback is given in a timely and effective manner."
As the health system's CMO, Anderson provides mentorship and coaching to RWJBarnabas' 12 hospital CMOs.
"Each of those chief medical officers report to me, and I mentor and coach them to be more effective leaders," Anderson says. "In turn, they have department chairs, program directors, and other physician leaders within their hospitals that they mentor and coach."
In addition to knowing the strengths and weaknesses of his hospital CMOs, Anderson strives to be transparent with the executives in his role as a mentor and a coach.
"I like to focus on the outcomes at a hospital, see how things are going, and offer help if there are opportunities for me to coach based on the things I am hearing," Anderson says. "I am transparent and have open conversations."
A three-member panel including two CMOs shares their perspectives on care teams.
In the latest edition of HealthLeaders' The Winning Edge webinar series, three experts discussed best practices for building and managing care teams.
With workforce shortages in the inpatient and outpatient settings across the country, building and managing care teams has become a critical issue for health systems and hospitals. One of the top challenges has been integrating an increasing number of advanced practice providers (APPs) into care teams.
The conversation included five tips for building and managing care teams: building interdisciplinary care teams, building a culture of compassion on care teams, integrating APPs into care teams, leading care teams, and off-loading tasks on care teams.
Tune in to view a video of the webinar to gain all the insights of the panelists on effective strategies to build and manage care teams, which help position healthcare organizations for success.
As part of The Winning Edge series, a three-member panel including two CMOs shares their perspectives on care teams.
The latest webinar for HealthLeaders' The Winning Edge series was held this week on the topic of building and managing effective care teams.
With workforce shortages in the inpatient and outpatient settings across the country, building and managing care teams has become a critical issue for health systems and hospitals. One of the top challenges has been integrating an increasing number of advanced practice providers (APPs) into care teams.
A three-member panel including two CMOs shares their perspectives on care teams.
The latest webinar for HealthLeaders' The Winning Edge series was held yesterday on the topic of building and managing effective care teams.
With workforce shortages in the inpatient and outpatient settings across the country, building and managing care teams has become a critical issue for health systems and hospitals. One of the top challenges has been integrating an increasing number of advanced practice providers (APPs) into care teams.
The conversation included five tips for building and managing care teams.
1. Building interdisciplinary care teams: Everyone on an interdisciplinary care team needs to feel valued and feel that they are impacting patient care, the panelists said.
It is helpful for discharges and inpatient care in general for interdisciplinary care teams to conduct rounds in the morning, including physicians, nurses, and pharmacists, one of the panelists said.
Although it can be difficult to form interdisciplinary care teams in the outpatient setting, they are crucial to providing high quality and safe care in many specialties such as cancer care, a panelist said. In the outpatient setting, it is helpful to co-locate clinicians in the same building so they can communicate easily, the panelist said.
Technology such as a chat function in the electronic health record can foster good communication between interdisciplinary care team members and support a collegial environment, a panelist said.
2. Building a culture of compassion: Fostering compassion on care teams supports quality, access, and timeliness, a panelist said.
Although care team members may feel overworked or burned out, keeping a focus on the patient and the patient's needs bolsters compassion, according to one of the panelists.
In addition, a panelist said it is imperative for healthcare leaders such as CMOs to respect that care team members have a life outside of medicine to support a compassionate environment. Healthcare leaders should not make value judgments about the commitment of care team members because everyone has a unique approach to setting a work-life balance.
Healthcare leaders should also lead by example and demonstrate compassion in the workplace. In this sense, compassion is contagious, with the leader demonstrating compassion and the care team members following suit.
3. Integrating APPs into care teams: First and foremost, APPs such as physician assistants and nurse practitioners want to feel that they are valued members of care teams, according to one of the panelists.
Although many APPs want to practice independently, it is important for them to recognize that they do not have the same level of training as physicians, a panelist said. With this in mind, APPs need to know when to ask for help without worrying that other care team members question their ability.
In highly specialized fields such as cancer care, experienced APPs can practice independently for follow-up visits, according to one of the panelists.
There is variation in how APPs are used in inpatient and outpatient settings, depending on the specialty involved. There is no single model for APP utilization at health systems and hospitals.
4. Leading care teams: Care teams can be led by physicians or by APPs and nurses, the panelists said.
As long as APPs and nurses have strong training and confidence, they can be well suited to leading a care team. Given the workforce shortages that health systems and hospitals face, it is important to not be prescriptive or firm on who can lead care teams, a panelist said, adding the decision on who is best positioned to lead a care team depends on the qualities of the individual.
When care teams are not led by physicians, healthcare leaders such as CMOs should put communication channels in place to let patients know who is in charge of their care, a panelist said.
5. Off-loading tasks on care teams: Technology and support staff can ease non-patient-care burdens on care teams, according to the panelists.
Physical scribes and ambient AI tools can record a conversation between a clinician and a patient, then generate a clinical note in the electronic health record. AI tools can also respond to messages in clinicians' electronic in-boxes, particularly when a message only requires a "thank you" or "see you soon" response, according to one panelist.
Clinicians review AI-generated responses to patient messages now, but AI tools will be able to respond to patient messages without review in the future.
APPs and nurses can work on documentation at a centralized location, a panelist said. Additionally, in any case where staff have care team responsibilities delegated to them, the support staff must feel supported and valued.
These CMOs think differently about whether care teams should always be led by physicians or whether they can be led by APPs or nurses in some circumstances.
With workforce shortages impacting health systems and hospitals across the country, the effective formation and management of care teams is more important than ever.
The physician shortage in many specialties is particularly challenging for care teams. Health systems and hospitals have risen to this challenge by employing more advanced practice providers (APPs) to maintain care access and lighten the load on physicians.
In recent conversations with HealthLeaders, a pair of CMOs gave different takes on whether care teams should always be led by physicians or whether it is appropriate for care teams to be led by APPs or nurses in some circumstances.
"Multidisciplinary care teams should be collaborative, with flexibility to adapt based on the patient's needs and setting," Kalman says. "Whether in the hospital or outpatient clinic, well-structured teams ensure the best outcomes."
While the growing role of APPs helps address physician shortages, physician-led teams provide the optimal structure for delivering high-quality, patient-centered care, according to Kalman.
In a well-designed care model at Northwell, different team members contribute their expertise, with physicians providing oversight and team decision-making for complex cases. Kalman highlights the importance of flexibility.
"An advanced practice provider may manage a patient’s diabetes and hypertension, but if that patient presents with rapid atrial fibrillation and a fever, physician consultation is essential to determine next steps," Kalman says.
Physicians, APPs, nurses, pharmacists, respiratory therapists, and other healthcare professionals all play key roles in guiding a patient through their care at Northwell, with physicians providing clinical oversight, Kalman says.
APPs such as nurse practitioners and physician assistants are going to play leading roles on care teams more often, according to Suzanne Wenderoth, executive vice president and CMO of Tower Health as well as a HealthLeaders CMO Exchange member. Historically, CMOs and other healthcare leaders have thought that physicians should lead care teams under all circumstances, but that view is changing.
"Now, we recognize with both changes to laws in the states, which allow for full practice authority for advanced practice providers, and the physician shortage in the post-COVID era, there has been an evolution in our thinking," Wenderoth says.
At Tower Health, APPs and nurses are under consideration for leadership roles on care teams, Wenderoth explains.
"At Tower Health, we do believe that every care team should have access to a physician," Wenderoth says. "But whether care teams need to be led by a physician is up for discussion."
There are circumstances where a care team can be led by an APP or a nurse, according to Wenderoth.
"When we talk about leading care teams, we are really talking about making sure the leader has leadership skills such as maintaining accountability, demonstrating professionalism, and having good facilitation skills," Wenderoth says. "That can be done by a physician, advanced practice provider, or nurse."
Focusing on solutions
The next webinar in our Winning Edge series, which will be held on Tuesday, March 11, from 1 to 2 PM ET, will tackle managing care teams head-on. Discussion topics include fostering interdisciplinary teamwork on care teams, optimizing the role of advanced practice providers on inpatient and outpatient care teams, and whether care teams should be physician-led.
Our panel includes:
Joshua Bozek, CMO of Catholic Health's St. Catherine of Sienna Hospital;
Oren Cahlon, senior vice president and deputy chief clinical officer at NYU Langone Health;
Christopher Cheney, event moderator and HealthLeaders CMO editor; and
Tipu Puri, CMO of University of Chicago Medical Center.
This is not just another webinar—it is an opportunity to learn from the best in the business and take away strategies you can implement at your organization. Join us as we explore care teams in depth.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Please join the community at our LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
Paul Sierzenski, MD, is senior vice president and chief physician executive at Beebe Healthcare. Photo courtesy of Beebe Healthcare.
Susan Huang, MD, is chief physician executive at Providence and chief executive of Providence Clinical Network. Photo courtesy of Providence. 
J. Casey Chapman, MD, is CMO of GI Alliance. Photo courtesy of GI Alliance.
Andy Anderson, MD, MBA, is CMO and chief quality officer at RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.
