"If you do not have the right clinical champion, I don't care if it is the best AI in the world, it will be dead on arrival."
When it comes to adoption of AI tools, health systems and hospitals need to be cautiously optimistic, says Doug King, MBA, senior vice president and chief information officer at Northwestern Medicine.
There is an enormous amount of hype surrounding AI in healthcare. Health systems and hospitals are adopting AI tools from partners or developing their own AI tools internally.
"You should be optimistic but realistic," King says of AI adoption. "There is a lot of hype around AI, so you need to understand what an AI tool is actually doing. You need to validate that an AI tool does what it claims to be doing. You need to trust but verify."
Northwestern Medicine has adopted several AI tools, and the health system is open to using any AI technology that is clinically relevant and that adds value to patients or clinicians, King explained.
"We are primarily focused on two key areas when we are evaluating AI," King says. "The first area is around early disease state detection, and the second area is around clinical efficiency."
AI tools that can achieve early disease state detection provide value for patients, according to King.
"If we can identify diseases through algorithms, such as looking at images or looking at radiology notes,” King says, “it is better for the patient because we can identify diseases earlier and intervene with care to keep them healthier."
AI tools that achieve clinical efficiency provide value for clinicians, according to King.
"We want to find AI that boosts provider efficiency because there are not enough doctors and not enough nurses,” King says, “so anything that we can do to make them more efficient so they can see more patients through AI is helpful.”
Northwestern Medicine has a robust process to evaluate AI tools that the health system might adopt, according to King.
"We have a team of engineers that understands AI," King says. "They validate the technology. They understand how the algorithm works. If we are working with an outside partner, we have technical calls with the partner's AI team to make sure that the algorithm works."
Clinicians also play a crucial role in the adoption of AI tools at the health system, according to King.
When adopting AI tools, Northwestern Medicine looks for clinical champions who understand the technology, who want to own the initiative, and who can drive the technology with other clinicians throughout the entire health system, according to King.
"If you do not have the right clinical champion, I don't care if it is the best AI in the world, it will be dead on arrival," King says.
When a health system or hospital is working with an outside partner, safety needs to be a primary concern in the adoption of AI tools, says David Atashroo, MD, CMO of Qventus.
"You have got to make sure that you are working with a partner that has a track record of building AI models and doing it in a manner that is safe and secure," Atashroo says. "That does not come overnight. It takes a lot of experience to do that well."
Health systems and hospitals should also be able to determine a return on investment from AI tools. According to Atashroo, an AI tool should be designed to address a specific problem.
"At the end of every problem, there is a potential outcome that can generate a return on investment," Atashroo says. "The only way you can validate and substantiate the benefit of an AI tool is insofar as it is deployed to solve an acute problem, where you can measure the impact on the back end and determine the financial return."
Patient-facing AI tools
One of the emerging areas for AI in healthcare are tools that are patient-facing, according to King.
"Patient-facing AI is just starting to come out," King says. "We will see it become more and more robust over the next few years. No. 1, AI will allow the patient to engage in the healthcare system the way they want to engage it."
Patient-facing AI will allow health systems and hospitals to personalize the patient experience, according to King. For example, if a health system knows that a patient has a preference to go to a particular location, a patient-facing AI tool will be able to automatically serve up times for appointments at that location.
"If the patient wants to have a dermatology check, we will be able to offer particular locations and times for that appointment using a patient-facing AI tool," King says. "It will allow us to personalize the patient experience as much as possible."
Northwestern Medicine is piloting a patient-facing AI tool that helps clinicians respond to messages from patients, according to King.
"If you send your physician a note, whether you have a question about something in your chart or a question about your prescriptions, AI reads that and generates an automatic draft response for the physician to use," King says. "That allows the physician on average to be about 30% more efficient as far as sending those notes out."
The health system is planning to roll out another patient-facing AI tool by the end of the year, according to King.
A patient will be able to start a conversation with a chatbot symptom checker. The symptom checker will ask the patient a series of questions, then the responses will lead to an understanding of the patient's clinical need, and the AI will point the patient to a physician who can address the clinical need. The AI will get the patient to the right place and look for appointments, so the patient can make an appointment without having to call an office.
"That is an entire interaction between the patient and the health system without any human interaction," King says. "It goes from what the patient is experiencing, what the patient is feeling, then making an appointment that works for the patient. It is going to be sophisticated."
AI tools are becoming more patient-facing because they are on-demand as soon as a patient needs access to them, according to Atashroo.
"As a patient, it can be frustrating when they need an answer to a question, but the clinician is not available or on call, so they have to wait," Atashroo says. "AI tools can provide immediate access when a patient needs it versus when a clinician is available."
The new CMO of Newark Beth Israel Medical Center plans to continue pursuit of high reliability that he helped lead at a Boston-based hospital.
Supporting the quest for high reliability in healthcare should be a top priority for CMOs, the new CMO of Newark Beth Israel Medical Center says.
Scott Schissel, MD, PhD, became CMO of the 665-bed academic medical center, which is operated by RWJBarnabas Health, this month. He had been CMO and vice president of medical affairs at Brigham and Women's Faulkner Hospital in Boston, where he also served as associate CMO and chief of medicine.
Pursuing high reliability is one of Schissels' primary strategies, which he honed in Boston.
"We had a system of just culture, where patient care was examined from the perspective of systems improvement and accountability that goes beyond individual human error," he says.
Staff from all disciplines at the Boston-based hospital shared a vision of high reliability and worked collaboratively on care and quality goals, Schissel says.
"In addition, every decision we made in healthcare leadership placed the patient's best interest and safety at the center," he says. "Creating and maintaining this kind of culture is hard work, and it is a continuous process."
The first principle of high reliability is transparency around safety and quality for the organization, so that everybody from frontline staff to the most senior leadership are willing to engage and talk about safety events and quality metrics, Schissel says.
"The dialogue that ensues is one of constructive building as opposed to a punitive or disciplinary environment," he says. "It's more about engaging in a culture of continuous process improvement."
A good example is process improvement in patient safety, Schissel says.
"At Newark Beth Israel Medical Center, there is an excellent electronic safety reporting platform, which is accessible for all employees," he says. "It is also important to have a culture where employees want to report safety events, and they are encouraged to report their observations. It should be celebrated when someone raises a safety concern."
The medical center has a Good Catch Award, where employees are recognized for reporting safety concerns, Schissel says.
"This kind of culture has led to a reduction in our serious safety events by about 80%," he says.
There are core elements to promote a culture of patient safety reporting, Schissel says.
"One is education of staff," he says. "Even at the point of onboarding, we train employees about our culture of safety, demonstrating that new employees know how to use the performance improvement tools and the safety reporting tool."
Maintaining that culture is also important, Schissel says.
"That has many avenues, from leadership rounding on the units to encourage and engage staff in reporting safety events to safety huddles on the units to a hospital leadership safety huddle," he says. "We are educating and reinforcing patient safety reporting on a daily basis."
Scott Schissel, MD, PhD, is CMO of Newark Beth Israel Medical Center. Photo courtesy of RWJBarnabas Health.
Promoting patient safety
The safety reporting system and safety culture at Newark Beth Israel Medical Center are foundational, Schissel says.
"Those are the most fundamental pieces of patient safety, so we can act on trends and individual safety events to make corrective action plans and process improvement," he says.
Promoting patient safety involves extending the work that has been done around safety reporting, Schissel says.
"When we receive a safety report, we are going to look hard at our response, which is through root cause analysis or interdisciplinary case review," he says. "We want to drill into how we methodically look at case events, so that when we make corrective actions, we are addressing the underlying root causes to minimize the recurrence of events."
The medical center's quality and safety teams look at all safety event reports daily, with supervision from Schissel and nursing leaders.
"We immediately engage the frontline unit where the event occurred, including their directors and staff, to obtain information," he says. "We review every safety event and plan different levels of root cause analyses, so that we address the underlying drivers of an event."
Best practices for promoting quality
Efforts to promote quality should be data-driven, Schissel says.
"The most important start to a quality program is to be sure you are dealing with the highest and best quality data of your clinical outcomes," he says.
Newark Beth Israel Medical Center has quality dashboards available to the staff that capture key metrics, such as hospital-acquired conditions and mortality, which are benchmarked against national standards, Schissel says.
"We are holding ourselves accountable to performance at a national level, not just our own year-to-year quality changes," he says. "We set clear goals to improve our quality metrics. Even if we are within the national benchmark, we always want to do better."
The medical center looks for opportunities for improvement in quality metrics no matter how well the hospital is performing, Schissel says.
"We have robust data around where our quality is doing well, on target, or falling short," he says. "We have a broad corrective action plan to address our performance."
"We look at core quality metrics every month," he adds. "We reassess where our interventions are working or not working like we want them to work. When needed, we institute new care protocols and care bundles. Like many hospitals, we can address conditions such as sepsis and heart failure by implementing care bundles or packages to enhance quality of care."
Part of providing quality care to patients with limited English proficiency is communicating with them in their own language, an AdventHealth CMO says.
CMOs need to ensure that health systems and hospitals have translation services for patients with limited English proficiency, the CMO of AdventHealth Apopka says.
In 2019, 67.8 million people in the United States spoke a language other than English in the home, according to the U.S. Census Bureau. Spanish was found to be the most common non-English language spoken in U.S. homes.
"Having translation services is critical to serve all patients consistently throughout the country," says Omayra Mansfield, MD, CMO of AdventHealth Apopka, an 158-bed hospital in Apopka, Fla., operated by AdventHealth.
"It should be a CMO's top priority to make sure we have the ability to communicate with our patients," Mansfield says. "Otherwise, you would never be able to deliver the type of care that we aspire to deliver."
A CMO should want patients to get high quality care like family members, and the ability to communicate is essential to attain quality, according to Mansfield.
"As a CMO, I care that my patients are treated like family," Mansfield says. "I can't imagine in a country like ours, which is so beautifully diverse, that we would have the ability to speak every language and every dialect just with the workforce that we have onsite."
AdventHealth Apopka's approach
Technology plays a role in how AdventHealth Apopka communicates with patients who have limited English proficiency. The hospital has contracted with a company that provides medical translation services virtually through video-enabled iPads capable of conducting three-way communication between clinicians, patients, and translators.
"We are able to navigate and identify what language the patient speaks—in particular what dialect," Mansfield says. "Then we connect with an interpreter so we can have communication with the patient in real time and in person."
By working with a translation service that specializes in medical communication, AdventHealth Apopka is ensuring that non-English speaking patients can understand medical terminology and care plans, according to Mansfield.
"We know the interpreter is capturing accurately what we are sharing and communicating to the patient," Mansfield says. "Similarly, we are getting the patient's responses, their questions, and their general understanding of the care plan as well."
For communicating with patients in general, and non-English speaking patients in particular, Mansfield uses the analogy of eating a pineapple, which is done in chunks rather than all at once.
"We need to provide small pieces of information—allowing the patient to digest those small pieces of information and ensuring understanding of information before we move on to the next chunk," Mansfield says.
Patience is also important when fostering clear communication with non-English speaking patients, according to Mansfield.
"We may have to take an additional step simply because of a language difference to be able to share information," Mansfield says. "Having patience is the only way we are going to give the care delivery we would want as if the patient was a loved one."
Another best practice for communicating with patients who have limited English proficiency is a process called teach back, Mansfield explains. After medical information has been shared with the patient, the translator is asked to prompt the patient to repeat back their understanding of what has been shared.
"That is one of the ways that we can adequately have confidence that our patients are understanding what we are sharing with them," Mansfield says. "If patients do not show an understanding of what we are sharing with them, we have to take the time to communicate in a different way to make sure they have understanding."
A longtime member of the HealthLeaders CMO Exchange discusses physician well-being, the evolution of advanced practice providers, and the impact of AI and technology on care delivery.
Denver Health CMO Connie Savor Price, MD, MBA, recently talked with HealthLeaders to preview some of the topics that will be discussed at this year's CMO Exchange.
The CMO Exchange is HealthLeaders' premier networking and peer-to-peer learning opportunity for CMOs, chief clinical officers, and chief physician executives. This year's event will be held from Sept. 18 to Sept. 20 at Miramar Beach, Fla.
In this podcast, Price, who is a longtime CMO Exchange member, highlights CMO Exchange discussion topics, including physician well-being, the evolving role of advanced practice providers (APPs), and the impact of technology and artificial intelligence on care delivery.
When it comes to physician well-being, it is important to realize that physicians are not averse to working long hours and tackling challenging situations, according to Price.
"What you need is a well-rounded work environment," she says.
There are several elements of a well-rounded work environment, according to Price.
You need to promote things outside of direct patient care
You need to address a good work-life balance
You need to provide mental health supports for some of the challenging situations
You need to reduce the chaos in work
You need to offload some of physicians' mundane tasks to others on the care team
You need to promote a sense of community in your work environment
Connie Savor Price, MD, MBA, is CMO of Denver Health. Photo courtesy of Denver Health.
The increasing number of APPs on care teams is a largely positive development, according to Price.
"They have become part of the team, and the idea is to expand access to healthcare when physician availability is limited," she says.
CMOs and other healthcare leaders need to be thoughtful in pairing physicians with APPs, according to Price.
"We need to address the best ways to partner physicians with APPs to ensure seamless care," she says. "One could argue that some of the diagnostic dilemmas might be best handled by physicians, while other more protocolized care might be the domain of APPs."
AI that does ambient listening during physician-patient encounters then produces high-quality clinical documentation is one of the most powerful applications of AI in healthcare so far, according to Price.
"This is something that physicians have long been wanting—to be able to have a conversation with a patient without having to worry about the details of the medical record and without having to worry about the details of billing and getting the words right in the medical record," she says. "Physicians have been looking for help in clearly communicating what happens in a patient care episode."
Decision support is another area where AI and technology are transforming care delivery, according to Price.
"It is something that helps us enhance our APP workforce," she says. "If you can combine some of those tools with the expertise of a physician and involve the APP workforce, you can get high quality care that meets the needs of a large number of patients with a relatively small workforce."
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.
A spike of antimicrobial resistant pathogens during the coronavirus pandemic does not bode well for the future.
The incidence of six bacterial antimicrobial-resistant hospital-onset infections increased in 2022 compared to 2019, according to a recent report from the Centers for Disease Control and Prevention (CDC).
The spike in antimicrobial resistant pathogens was likely caused by the impact of the coronavirus pandemic, according to the CDC. Drivers of the spike include longer lengths of stay, disruption of infection prevention practices, and increased inappropriate antibiotic use, the CDC says.
The increased incidence of antimicrobial resistant pathogens should be a top concern for CMOs, according to Anurag Malani, MD, medical director of hospital epidemiology, antimicrobial stewardship, and special pathogens at Trinity Health St. Joseph Mercy, which is part of Livonia, Michigan-based Trinity Health.
"CMOs should be concerned about antimicrobial resistant pathogens because patients who have these infections do not do as well as other patients," Malani says. "Their outcomes are not as good. They are more difficult to treat. They stay in the hospital longer. They incur more costs."
Additionally, an antimicrobial resistant infection in a patient can spread to other patients, which is a risk, he says, adding that these infections can increase mortality rates.
"There is a risk of dying from these infections," Malani says. "Ultimately, that is why CMOs should care about antimicrobial resistant pathogens."
The CDC report found increased incidence of the following antimicrobial-resistant hospital-onset infections during the pandemic:
Among the seven antimicrobial-resistant hospital-onset infections monitored by the CDC, only methicillin-resistant Staphylococcus aureus showed no sign of increasing during the pandemic. The incidence of Candida auris rose five-fold from 2019 to 2022.
Trinity Health St. Joseph Mercy has seen similar patterns with antimicrobial resistant pathogens as the CDC data, with several infections that have been difficult to treat in 2024, according to Malani.
"For example, Candida auris is a type of fungal infection that is very difficult to treat," Malani says. "Its prevalence in Michigan is much higher than it was pre-pandemic. It has become common in hospitals across Michigan."
Antimicrobial resistance can be hard to measure, according to Malani.
"It is hard to measure at a local site because you do not practice care in a vacuum," he says. "It is evolving, and it is impacted by other hospitals and health systems."
That is why data from the CDC and the agency's National Healthcare Safety Network is crucial for health systems and hospitals to understand the evolution of antimicrobial resistant pathogens, Malani says.
"We are going to be able to use this data in a region, in a state, and across health systems to help us in terms of surveillance," he says.
For health systems and hospitals, best practices for addressing antimicrobial resistant pathogens include having antimicrobial stewardship and infection prevention programs, according to Malani.
"Antimicrobial stewardship programs review patients, review whether patients have infections, determine whether patients are on the right antibiotics, and make sure patients are on the right duration of antibiotics," he says.
Hospitals have regulatory and accreditation standards around both antimicrobial stewardship and infection prevention, according to Malani.
"For example, if you are accredited by The Joint Commission, then you must have an antimicrobial stewardship program and an infection prevention program," he says.
The Centers for Medicare & Medicaid Services, which is the country's largest healthcare payer, also require hospitals to have antimicrobial stewardship and infection prevention programs, according to Malani.
Health systems and hospitals should also consider tying infection prevention and antimicrobial stewardship practices together.
"Across the continuum of care, we definitely need resources and expertise to do that," Malani says. "Many healthcare settings do not have that expertise. They don't necessarily have the funding, and they may not have the resources."
Looking to the future of antimicrobial resistant pathogens, there is cause for concern, according to Malani.
"Regarding my expectation for next year, antimicrobial resistance is here," he says. "We are going to have to figure out large-scale strategies to try to reduce the pressures on antimicrobial resistance. It could be more than how we use antibiotics."
Oswego Health has a comprehensive approach to patient safety, the health system's new CMO says.
Patient safety involves multiple facets, and it should be among the top priorities at health systems and hospitals, according to the new CMO of Oswego Health in New York.
Wajeeh Sana, MD, was announced as CMO of Oswego Health in early July. He has worked at the nonprofit health system since 2013. At Oswego Health, he has served as medical director and chairman of Oswego Hospital's emergency department and president of the Oswego Hospital medical staff.
Oswego Health takes a comprehensive approach to patient safety, Sana says.
For example, the health system uses two factors to identify patients. First, the organization performs medication safety. Second, Oswego Health conducts infection prevention, fall prevention, and suicide prevention, as well as calling a timeout before surgical procedures to make sure surgeons are performing the correct surgery on the correct patient.
The most recent patient safety initiative launched at Oswego Health is for fall prevention.
"We have developed comprehensive policies around fall prevention," Sana says. "Right now, we are in the process of providing education about fall prevention and implementation of the policies to our staff."
An essential element of the fall prevention initiative is identifying patients who are at high risk.
"We are educating staff on what to look for," Sana says. "High-risk patients include people who come into the hospital with an altered mental status, people who have mobility issues, and people who are on medications that can put them at high risk."
Wajeeh Sana, MD, is CMO of Oswego Health. Photo courtesy of Oswego Health.
Sana developed a keen understanding of physician engagement during his time as president of the Oswego Hospital medical staff, and he says there are four essential elements of physician engagement.
"First, you need clear communication with your physician leaders. Second, you need to value their input and their time because we all know how busy physicians are," Sana says. "Third, you should assign physician champions for different projects in your organization. Fourth, organizational support is important as well as rewarding the efforts of physicians."
CMOs should use a targeted approach when selecting physician champions, according to Sana.
"We look for leaders in their fields," Sana says. "These include medical directors and experts in their fields."
Having a clinical background in emergency medicine and serving as medical director and chairman of Oswego Hospital's emergency department helped prepare Sana to serve in the CMO role.
"In serving in an emergency room, you are a gateway to the hospital," Sana says. "You have patients coming in from primary care offices and consultants' offices."
"I was the emergency medicine medical director for 12 years," Sana says. "I managed multiple physicians and advanced practice providers. I was in contact with hospital leadership. In the emergency room, your role is to work with all consultants. So, I developed a good relationship with our medical staff, which makes my job as CMO easier."
Market challenge
Mirroring a national trend, recruiting physicians and other healthcare workers is the biggest challenge at Oswego Health, according to Sana.
"We have staffing challenges in primary care as well as specialty care such as in gastroenterology, neurology, and nephrology," Sana says. "We have done significant outreach and tried to hire more primary care doctors and the primary care practices have expanded over the past few years."
A couple of strategies adopted by Oswego Health have been successful in the recruitment of primary care physicians, according to Sana.
"We want primary care physicians to choose us as a place to work," Sana says. "We have concentrated on the quality of our primary care, so physicians want to work for us. We have also recruited physicians who have ties to our area."
For healthcare workers in general, Oswego Health has concentrated on building a strong human resources pipeline, starting as young as ninth grade, according to Sana.
"We have an early college health sciences program and have just graduated our first cohort," Sana says. "Through partnerships with our local community college, students come to our hospital and shadow multiple departments, including laboratory services, radiology, and finance."
The health system also has a robust tuition assistance program, according to Sana.
"If any employee wants to go back to school for roles such as medical imaging technician or degrees such as BSN or MSN, we will help pay for that," Sana says. "Tuition assistance is both a recruitment and retention tool for us. The investment in our staff has set us apart."
While CMOs concentrate on clinical areas such as patient safety and care quality, they also impact the bottom line at healthcare organizations. For example, managing cost of care is a key financial component of care delivery, and CMOs must understand financial connections like this to help ensure the success of their organizations.
"In leadership, it is imperative to have an acute understanding and keen awareness of the environment," says Scheinbart, the author of The Chief Medical Officer’s Financial Primer: The Vital Handbook for Physician Executives, which was published by the American Association for Physician Leadership. "Unfortunately, while physicians are expertly trained and highly specialized in clinical care, they do not always come with the knowledge of the finance environment that wraps around everything that a healthcare organization does."
"If there is a lack of awareness of the finance environment, it is an impediment to the success of all the stakeholders," he says.
Cost of care
Health system and hospital CMOs need to understand the cost of care at their organization, Scheinbart says.
"Early on, hospitals charged for the cost of care based on the cost of gauze, Band-Aids, and X-ray plates, for example, and it was passed on as a straight charge and payment was expected," he says. "We are nowhere in that universe anymore."
Cost of care has become more complex, Scheinbart says.
"To pay for hospital costs, there is a highly complex system of players who are involved in the dollars when the patient is in the hospital," he says. "So, the CMO needs to understand the cost of everything that occurs for the patient to bring value back to the hospital."
A CMO needs to know what costs are being incurred, who manages those costs, and the impact of those costs, Scheinbart says.
"If you carry these costs forward to the net margin of the institution and how that margin plays a significant role in the future prospects of the organization, not every CMO understands the criticality that they bear when it comes to the success of the organization," he says.
Revenue structure
CMOs also need to know the revenue structure of the organization.
Healthcare isn't like a kid's lemonade stand, Scheinbart says. CMOs need to be aware of not-so-straightforward transactions.
"Third parties pay for the care and adjudicate the payment in the process of the billing, claims, and collections," he says. "Those elements ought to be understood by CMOs because not everything is a straight payment. There are pathways and processes that bring the dollars into the organization. Then embedded in that are both incentives and penalties, particularly from the Centers for Medicare & Medicaid Services (CMS)."
A CMO, he says, may be tasked with improving a domain that is measured through Press Ganey, such as communication with doctors. That, too, has financial implications.
"There are questions that patients are asked when they are filling out their Press Ganey surveys," Scheinbart says. "When those surveys are collated, the results are given and there is a score. There can be money associated with the score. CMOs need to work with their revenue team and compensate physicians appropriately in their contract linked to that domain."
Press Ganey scores impact a hospital's CMS star ratings, which are indirectly tied to reimbursement from Medicare.
"The higher the star rating for the hospital, the greater payment to the hospital through value-based care," Scheinbart says.
Financing of health systems and hospitals
Above all else, Scheinbart says, CMOs should have a good understanding of how their health system or hospital is financed.
"A CMO might spend a lot of time dealing with quality and credentialling, but what they really ought to be doing is driving the financial health of the health system or hospital, so that the organization has working dollars to put back into patient care," he says.
CMOs should collaborate with CFOs to get a clear understanding of a health system's or hospital's financial structure and give CFOs a better idea of how clinical care affects those finances. The more CMOs and CFOs work together, the better their decision-making will be.
"CMOs may be responsible for a significant portion of quality and safety of patient care, but their efforts may lower the financial stability of the organization," he Scheinbart says. "This can hurt the bond rating for nonprofits or the underwriting ability for for-profit organizations."
For example, if a CMO does not manage cost of care, it can hurt the bottom line.
"In a nonprofit setting," he adds, "some CMOs who are new to the role may not understand that a $2 billion health system has a 3% margin, which is $60 million. That $60 million must be returned back into the health system by law. That $60 million gets carved up by every interested stakeholder, such as department heads who want an endoscopy suite or a patient transportation system."
In that case, a CMO must know how to advocate for care delivery improvements and be able to explain how those improvements boost the bottom line.
"For example, the CMO may understand that the work they do on length of stay elevates the health system by $1 million or $2 million in terms of revenue on the balance sheet," he says. "Then it is reasonable for the CMO to seek $350,000 for new software, so they can improve quality."
In addition to adding beds, hospitals with tight capacity must focus on operations reforms and new workflows.
Patient capacity is the biggest challenge at University of California Davis Medical Center, according to the hospital's new CMO.
Joseph Galante, MD, was named CMO of UC Davis Medical Center in July. He previously served as interim CMO of the medical center for a year and trauma medical director of the hospital for many years.
"Like many health systems, our biggest challenge has been capacity," Galante says. "We are full. Unlike other health systems that have beds that are not staffed, we have staffed all of our beds."
A unique element of the medical center's patient capacity crunch has been California's seismic compliance requirements, according to Galante.
"We have had to close 70 beds over the past year," Galante says. "By closing those beds, we had to find 70 new beds to open in different locations throughout the hospital."
UC Davis Medical Center has had to do more than open beds to address the facility's capacity challenge, according to Galante.
"You must apply the operations and work flows to be able to move patients more seamlessly and get them discharged," Galante says.
On the operations front, UC Davis Medical Center has instituted a program on the outpatient side to identify patients who are at high risk for hospital readmission, according to Galante.
"We have a patient navigator and nursing team that can help those patients navigate as an outpatient without returning to the emergency department and becoming readmitted," Galante says. "We call this our Multi-Visit Patients program."
New workflows have been added in the medical center's emergency department to boost patient throughput as well.
In most traditional emergency departments, patients would expect to check in, wait in the waiting room, get a bed, then care begins. However, the medical center has a process to start care as soon as a patient checks in, according to Galante.
"We have physicians at the front of the emergency department and patients can get care while they are waiting in the waiting room—you may leave the waiting room to get imaging studies or labs," Galante says. "Then you come back to the waiting room, but you are getting care without touching a bed, which helps with throughput and eliminates the need to wait for care."
Promoting patient safety and quality
Galante says patient safety and quality have been his top concerns as CMO, interim CMO, and trauma medical director at UC Davis Medical Center.
"We have a variety of different paths that we take for patient safety and quality," Galante says.
The medical center compares itself to Vizient rankings for other academic medical centers as well as metrics through The Joint Commission, according to Galante.
"We continue to monitor the metrics for patient safety and quality," Galante says. "Just as importantly, we do both bedside engagement of the physicians and nursing staff that deliver care as well as systems monitoring of the quality of care that we deliver."
The hospital's Patient Safety Events Committee reviews patient safety events daily. The medical center also engages patients to promote safety and quality, according to Galante.
"We have incorporated patients into our quality spectrum through the Speak Up program, where patients can alert us to issues that arise during their care," Galante says. "We have the Code Help Hotline, which patients can call to let us know that there are issues arising in their care."
With the Code Help Hotline, patients are given a phone number they can contact, and the calls go to the medical center's patient relations team.
"It not only alerts us to potential quality issues that come up, but also helps us remain patient centric," Galante says. "This service is for inpatients with urgent hospital needs."
Joseph Galante, MD, is CMO of UC Davis Medical Center. Photo courtesy of UC Davis Medical Center.
Clinical staff engagement
Engaging the clinical staff of the medical center was one of the key elements of serving as interim CMO, according to Galante.
"Coming out of the coronavirus pandemic, our staff and physicians have been under stress and have been experiencing burnout," Galante says.
To engage staff, a CMO must be present and available for healthcare workers, according to Galante.
"I have been able to do some clinical care each week, so people see me in my scrubs working in the hospital," Galante says. "Additionally, I try to go out each week and meet with different teams to engage them in their workplace, so they see the CMO. I ask questions, engage them, and find out how we can help them overcome barriers they are experiencing while delivering care."
Coping with high costs
The medical center has been experiencing high costs in the labor arena and from inflation's impact on supply costs, according to Galante.
"The pandemic certainly did not help us on either of these fronts," Galante says. "Workforce shortages are driving up labor costs across the entire spectrum of our staff."
To contain labor costs, the medical center has been focusing on recruiting full-time staff rather than employing contract labor such as locum tenens physicians, according to Galante.
"Temporary labor can cost about two times what hiring permanent staff costs," Galante says. "If you can hire someone into your organization and build them into your culture, the amount of time that they stay makes it worth the recruitment costs that are invested up front."
In addition to hiring full-time staff, the medical center needs to ensure that full-time staff are productive, according to Galante.
"That involves eliminating low-value work," Galante says. "It helps to bring in technology to eliminate continuous monitoring of patients and note taking functions. You want to get people to work at the top of their licenses."
To address high supply costs, the medical center is taking advantage of the purchasing power associated with being part of a large health system, according to Galante.
"We can leverage as a joint system to be able to contain costs and negotiate lower prices from supply vendors," Galante says. "We can come up with reasonable contracts through our purchasing power. We also have done some work with inventory management to make sure that we are not overstocking."
CMOs and other healthcare leaders need to employ several strategies to restore trust, such as pushing back on misinformation about who profits from vaccines.
Trust in physicians and hospitals fell from 71.5% in April 2020 to 40.1% in January 2024, according to a new research article.
The trust patients place in physicians and hospitals is an important concern for CMOs and public health officials. If patients do not trust physicians and hospitals, they are less likely to follow their recommendations.
The coronavirus pandemic marks a turning point for trust in physicians and hospitals, says the lead author of the research article, Roy Perlis, MD, MSc, associate chief of research in the Department of Psychiatry and director of the Center for Quantitative Health at Massachusetts General Hospital.
"Prior to the pandemic, many physicians took it for granted that people would trust them," Perlis says. "Unfortunately, because there was so much misinformation and politicalization of healthcare during the pandemic, a lot of the initial trust in physicians and hospitals was squandered. What we have realized is that we need to rebuild trust if we are going to support public health in the future."
The loss of trust during the pandemic was not a surprise for the researchers, according to Perlis.
"Unfortunately, during the course of the pandemic, especially with the spread of misinformation about COVID and the vaccine, trust declined substantially," Perlis says. "We were not surprised that trust declined, but we were surprised by the magnitude of the drop."
The research article is based on survey data collected from more than 440,000 U.S. adults. In addition to the finding that trust in physicians and hospitals dropped 31%, the study, which was published in JAMA Network Open, includes three key results:
Higher levels of trust were associated with a higher chance of vaccination for COVID-19 (adjusted odds ratio 4.94) or influenza (adjusted odds ratio 5.09), as well as getting a COVID-19 booster (adjusted odds ratio 3.62).
Characteristics linked to decreased trust included being 25 to 64 years of age, female, lower educational level, lower income, Black, and living in a rural area.
When survey respondents were asked why they had lower levels of trust, the reasons cited included financial motives over patient care, poor quality of care and negligence, influence of external entities and agendas, and discrimination and bias.
Roy Perlis, MD, MSc, is associate chief of research in the Department of Psychiatry and director of the Center for Quantitative Health at Massachusetts General Hospital. Photo courtesy of Mass General Brigham.
Trust is essential to convince patients to follow recommendations such as vaccination, according to Perlis.
"If your doctor is telling you to do something either directly or through the hospital where you get your care, there is no reason to follow the recommendations if you do not trust what you are being told about something like vaccination," Perlis says. "That is one of the reasons why it is imperative that we restore trust."
Loss of trust is different for different groups, according to Perlis.
"Some of them may be more likely to have had bad experiences with healthcare. Historically, we know that we have not necessarily treated all groups equally well," Perlis says. "Unfortunately, public health became politicized during the pandemic, and some of the groups that were associated with less trust had more exposure to the politicization of healthcare."
For survey respondents, the reasons for loss of trust broke down into several categories, according to Perlis:
One reason was bad experiences in terms of their own care or the care of a family member.
There were concerns about conflicts of interest.
People were worried that doctors or hospitals may have financial motives rather than simply being focused on providing the best care.
There was concern that doctors or hospitals might be influenced by outside entities or outside agendas.
There was a subset of survey respondents who had experienced discrimination or bias in their interaction with the healthcare system.
Restoring trust in doctors and hospitals
There are several steps that CMOs and other healthcare leaders can take to restore trust, according to Perlis.
"It is one thing to say trust is down," Perlis says. "It is another thing to think about how we can repair trust, which we will need for all kinds of public health initiatives, including the next pandemic and anything that involves intervening to improve public health. We absolutely must prioritize restoring trust."
Strategies to restore trust will have to be crafted with the reasons why trust has eroded.
"The strategies to restore trust probably aren't a one-size-fits-all response," Perlis says. "They need to address some of the underlying concerns."
There are several ways that CMOs and other healthcare leaders can show people that conflict of interest does not drive decision-making.
"For example, we have transparency laws that make it easy for people to see whether their doctor is being paid by someone other than the hospital," Perlis says.
CMOs and other healthcare leaders need to push back on misinformation about who profits from things such as vaccines or medications.
"Simply clarifying who pays for these things and who benefits from them financially is important," Perlis says.
For people who have had bad experiences with healthcare or feel they were not treated well, that is more difficult to address.
"We need to find ways to re-engage with these people," Perlis says. "One way to do that is to listen. We can get people in to see their doctor and find out why they had bad experiences."
CMOs and other healthcare leaders need to make it easier for people to interact with the healthcare system.
"There are many reasons people get frustrated such as long wait times to see doctors," Perlis says. "We need more outreach and more accessibility."
CMOs need their physicians to be addressing prescription overload.
For patients on multiple medications, deprescribing is a key strategy to promote patient safety and care quality.
The primary risk with multiple medications is medication interactions. This risk can lead to an increase or decrease in the effects of medications as well as undesired effects and side effects.
Cost and waste are other considerations, according to Karna Patel, MD, MPH, vice president at Tampa General Hospital and president of Tampa General Medical Group.
"As you add more medications, there is more cost to pay for those medicines," Patel says. "Globally, prescribing multiple medications can lead to waste of pharmaceuticals."
When assessing patients on multiple medications, clinic visits and visits in other healthcare settings are an opportunity to go over a patient's medication list, according to Patel.
"At that time, we want to make sure all the medications the patient is taking are appropriate for their conditions," Patel says. "We also check for interactions. That is a great time to try to deprescribe or consolidate medications."
For example, there may be three medications for three conditions, but there are medications that can be used for treating more than one condition, according to Patel.
"We want to look for an opportunity to use one medication rather than three medications," Patel says. "Deprescribing is one way to move forward when a medication is not needed and you can consolidate medications, so you are prescribing only the medications that are absolutely needed for patients."
Cymbalta is an example of a medication that clinicians can use to deprescribe and consolidate medications, according to Patel.
"Cymbalta is a medicine that is approved for anxiety, depression, neuropathy, and chronic pain," Patel says. "In many cases, patients take multiple medications to address those problems, and there is an opportunity to discontinue those medications and switch to Cymbalta, which can help with all of those conditions."
At Tampa General Hospital, referrals to pharmacists are also an opportunity to assess patients on multiple medications, according to Maja Gift, MHA, BS Pharm, senior director of pharmacy services at the academic medical center.
"We may have a physician who is concerned that a patient is on a lot of medications, and they will issue a referral to a pharmacist to conduct a review," Gift says. "Pharmacists have a lot of training, and they know a lot of details about medications, so it makes sense to pull them into a situation where a medication review is required."
Deprescribing best practices
The first step in deprescribing is looking at the current clinical status of the patient and their list of conditions, according to Patel. Then, clinicians should look at the medications and the evidence-based guidelines to see which medications are necessary and aligned with the evidence-based guidelines, and which medications are well tolerated by the patient, he says.
"Keeping all those things in mind, you go down the list of medications and make the decision of which ones to keep and which ones to discontinue," Patel says. "In addition, you want to look at which medications can be consolidated to address multiple problems."
Medication therapy management is the process for deprescribing, according to Gift.
"That process includes having a pharmacist review every medication a patient is on, evaluate for drug interactions, and evaluate for duplication of therapy because one medication can be enough instead of multiple medications," Gift says.
Medication therapy management is reimbursed by the Centers for Medicare & Medicaid Services as well as most commercial payers, according to Gift.
Best practices for deprescribing include allotting time to do the job, according to Patel.
"If there is a long list of medications, it can take 30 minutes to go through everything and make sure that you can consolidate and deprescribe," Patel says.
Another best practice for deprescribing is knowing when a medication should not be discontinued abruptly, according to Patel.
"Some medications require tapering, especially medications that have the risk of withdrawal," Patel says. "Other medications that do not require tapering can be stopped without being concerned about withdrawal symptoms."
Why multiple medications should concern CMOs
Multiple medications for patients should be on a CMO's radar because medication management is a component of value-based care, according to Patel.
"We are focused more on patient experience, quality, outcomes, and cost of care," Patel says. "Medication management is an important area for CMOs and health systems because if we are aiming for all of those things, we want to make sure patients are getting the medications that are needed—not multiple medications that are duplicated or are interacting."
There are other reasons CMOs should be concerned about patients with multiple medications, according to Patel.
"The side effects that can result from multiple medications can lead to increases in healthcare utilization, risk of going to the emergency department, hospital admissions, or ICU stays," Patel says. "There are other risks such as impacting the quality of life from falls or other injuries."