Crucial AI governance capabilities include understanding how AI tools are being used and monitoring of AI tools to reduce or eliminate unintended consequences.
Health systems should put a governance structure in place early in their AI adoption process, a top executive at Community Health Network says.
"You need to have the governance in place to make sure that you understand all of the tools that are being used, how the tools are being used, the intended outcome of usage, and how you mitigate bias," says Patrick McGill, MD, MBA, executive vice president and chief transformation officer of the Indianapolis-based health system. "Having a governance structure in place from the beginning is helpful."
HealthLeaders is conducting its AI in Clinical Care Mastermind program through December. The program brings together nearly a dozen healthcare executives to discuss their AI strategies and offerings. As part of the program, each of the panelists are talking with HealthLeaders about the use of AI in clinical care.
CHN recently hired a director of AI and data governance, who will be standing up an executive steering committee to help identify and prioritize AI tools and use cases.
The members of the executive steering committee will include McGill along with the health system's CFO, CMO, chief physician executive, chief information officer, and technical staff from IT and analytics.
"The focus of the executive steering committee will include prioritization of projects; implementation and use of policies, procedures, and traditional governing functions that must be put in place; resource allocation; and oversight of the monitoring of AI tools to reduce or eliminate bias and other unintended consequences of AI," McGill says.
Monitoring is a crucial AI governance function and varies based on various AI tools, McGill explains.
"Some of the monitoring will be through data reports," he says. "Some of the monitoring will be third-party partnerships to monitor the performance of an AI model. A third approach to monitoring will be to understand how third-party partners are using our data—we want to know whether data is de-identified, whether data is going out to a publicly available large language model, and what data the AI model is built on."
Prior to establishing the executive steering committee, the health system began the process of creating AI governance capabilities, according to McGill.
"We have put in policies, procedures, and guardrails for the appropriate use of AI," he says.
Patrick McGill, MD, MBA, is executive vice president and chief transformation officer at Community Health Network. Photo courtesy of Community Health Network.
Community Health Network's AI models
Like most health systems that have adopted AI tools, CHN is using ambient listening and ambient documentation to decrease administrative burden on clinicians.
"We partnered with DAX Copilot for the past year and a half, so we are using that technology across almost all of our outpatient specialties," McGill says. "It is helping people document faster and get out of the clinic faster. They can close their charts efficiently."
The health system recently adopted Secure GPT via a partnership with Qualified Health, which is HIPAA compliant. Clinicians can use the AI model to ask clinical questions and put in clinical information if they need to generate a letter.
"Clinicians are using it for note summarization and rapid look-up of clinical information such as the maximum dose of a certain medication," McGill says. "It is helping clinicians to get quick answers. Clinicians are using it for clinical workflows such as generating a consult letter or generating a summary—any information they might need to make the clinical workflow be more efficient."
One of the newer AI tools that CHN is adopting in a partnership with Notable, McGill says, will help streamline clinical workflows.
"For example, it will read a mammogram, identify whether the patient has an abnormality and needs additional imaging, and initiate a referral for the additional imaging," he says. "If the patient needs additional follow-up such as a breast MRI in six months, the AI tool will identify that need, then generate a referral for that follow-up."
Radiology is the focus for this AI tool now, but there are potentially other use cases with lab reports and procedure reports, McGill says.
Another new AI tool that the health system is piloting can conduct chart summarizations specific to a clinician—what the clinician's preferences are and what the clinician needs to know or wants to know before walking into a room to see a patient.
"This AI tool will automate a lot of manual work, and it is reading the chart to pull out nuggets of information that previously you had to have a human do," McGill says.
AI impact and advice
The health system's clinical care teams are giving positive feedback on the adoption of AI tools, according to McGill.
"AI is taking administrative work off their plate," he says. "It is removing administrative burden and allowing clinicians to focus more on taking care of patients. Often people are resistant to using new technology, but the feedback that we are getting on our AI tools has been welcoming."
In addition to establishing governance capabilities early in a health system's AI journey, McGill offers two pieces of advice to others who are adopting AI tools.
"One, you must include the clinicians in AI adoption from the beginning," he says. "Two, you must be willing to take chances. These tools are new, and they are not perfect, but they are only going to continue to get better. If you are only going to move forward with perfection, the train is going to go past you."
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The Cincinnati-based health system's new chief clinical officer wants to create a culture of safety and stability.
The new chief clinical officer of UC Health is looking forward to helping the academic health system on its journey toward high reliability.
Arthur Pancioli, MD, assumed the role of senior vice president and chief clinical officer at UC Health in August. Prior to taking on his new position, he was chief transformation officer of the health system. He has a clinical background as an emergency medicine physician.
This year, UC Health launched an initiative to become a high reliability organization.
"Many healthcare organizations across the country have taken on the concept of high reliability," Pancioli says. "It is a well-studied science that is a methodology of improvement of an entire organization. We have just entered an engagement with a consultancy, and we are starting our journey to high reliability."
The first step in this process, he says, is assessment.
"The first thing you do is determine your current state and opportunities for improvement in high reliability, which is the pursuit of zero harm in a highly complex organization," Pancioli says.
"This will require that we truly see a culture shift and a mindset shift and a whole new way of doing things in this organization," he adds. "When we get it right, we can be what we aspire to be."
Pancioli says the most challenging part of this transformation will be enacting cultural change.
"You must create a culture of psychological safety, and you do that by defining the rules in ways that people understand," he says. "You highlight the behaviors you hope to see when they are modeled and demonstrated to set expectations. You also need to highlight behaviors that are not OK, and let the staff know how the organization will deal with them."
To establish a culture of psychological safety, a health system must shift away from a culture of blame and shame, Pancioli explains.
"An individual should not be blamed for an error unless it is volitional," he says. "Our people are doing complex things, and we need to address systems that set people up for the potential of errors."
Arthur Pancioli, MD, is senior vice president and chief clinical officer at UC Health. Photo courtesy of UC Health.
The health system's leadership team is playing a key role in the high reliability initiative.
"Like any major initiative, it requires abject buy-in from the leadership and a system where the behaviors that you hope percolate throughout the organization are modeled by the leadership," Pancioli says.
Frontline caregivers will also be crucial to implementing the initiative.
"You must engage frontline workers as subject matter experts and defer to them about the elements of the health system that need change," Pancioli says. "You can't do everything from the top down."
At health systems and hospitals, promoting high reliability requires an emphasis on patient safety.
"We have dedicated safety experts at every site of our organization," Pancioli says. "They are trained in avoiding potential harm to patients. They document near misses and see what we can learn."
"We have rigorous detection of errors, whether or not there is an impact on patients," he adds. "When there is an impact on patients from errors, that prompts a root cause analysis by a team using structured methodologies."
UC Health is working with healthcare technology company symplr to automate the adverse event reporting process. Staff are able to develop adverse event reports through the EHR platform.
"Because it is a standardized program specifically designed for this type of work, it leads us in information gathering," Pancioli says. "It starts a process to not only examine a singular event but also allows us to aggregate events and look for systemic causes of adverse events."
UC Health has "myriad triggers" for detecting medical errors and near misses, including staff reporting and patient complaints, according to Pancioli.
"For every reporting agency that we work with such as the Centers for Medicare & Medicaid Services, we have standard reporting of errors," Pancioli says.
With the AI landscape changing constantly, health systems need to watch their steps when applying the technology to clinical pathways.
Health systems should proceed cautiously in adopting AI tools, according to a top executive at UMass Memorial Health.
HealthLeaders is conducting its AI in Clinical Care Mastermind program through December. The program brings together nearly a dozen healthcare executives to discuss their AI strategies and offerings. As part of the program, each of the panelists are talking with HealthLeaders about the use of AI in clinical care.
The pace of change in AI is so fast that health systems must watch their steps as they adopt AI tools, says Eric Alper, MD, chief quality officer and chief clinical informatics officer at UMass Memorial.
"There are so many AI platforms that are being developed at this point that we must make good decisions about what platforms and models to implement," he says.
Healthcare leaders need to be smart about evaluation, and they need to understand where they are going to achieve the greatest value from AI, Alper says.
But first, he says, they need to establish a governance strategy.
"There is so much happening so fast in this space, including regulations, guidelines, and tools that are being released,” he says. “That is going to continue to evolve. So, you must have your set of experts lined up as more AI tools are released and there are changes in the environment."
UMass Memorial has established an AI governance committee specifically designed to help conduct the adoption and implementation of AI in clinical care.
"We are establishing a policy and a process for working through the different kinds of AI tools that are being requested at the organization," Alper says. "The AI governance committee will help us implement AI tools in the safest way."
The governance committee has several representatives from key areas at the health system, including clinicians, IT staff, legal team members, risk management staff, ethicists, and people who are focused on health equity.
"Choose wisely and do your due diligence," Alper says.
Eric Alper, MD, is chief quality officer and chief clinical informatics officer at UMass Memorial Health. Image courtesy of UMass Memorial Health.
UMass Memorial's AI tools
So far, the AI program that is having the biggest effect on clinical care teams at UMass Memorial is one that enables ambient listening documentation, according to Alper. At least 150 clinicians are using Nuance’s Dragon Ambient eXperience (DAX) tool.
During the clinician-patient encounter, the clinician first asks for the patient’s permission to use the tool, which is integrated into the Epic EHR. After the clinical encounter is done, the documentation note appears in the patient's chart within seconds.
"The people who are embracing DAX have been saying that it is transformative for them," Alper says. "They are finding it provides high-quality documentation with a lot less effort."
Another program, Alper says, uses AI for retina screening.
"We have been working with a company called AEYE Health," he says. "They are capturing retinal images of patients in the primary care setting, then they do AI image recognition to see whether there are any signs of diabetic retinopathy. If there are signs, a referral is made to an ophthalmologist."
UMass Memorial is also using AI in radiology, where the health system is working with Aidoc.
"They have put in place about 17 different models to look for findings on radiology images to try to identify those findings earlier as well as to help the radiologists to make sure they see critical findings that may come up," he says. "It helps us take care of patients more safely."
Beyond working with vendors, UMass Memorial is collaborating with the Massachusetts Institute of Technology to develop an AI tool that predicts hospital length of stay and monitors patient deterioration.
"Almost all of the AI that we are using has been developed by someone else," Alper says. "We are building on top of these AI tools and configuring them. The only AI tool that we have created within UMass Memorial has been the tool for predicting length of stay, which we are still developing and evaluating."
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs. To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Sentara Medical Group is planning to double the number of its APPs over the next three years, according to this CMO.
Advanced practice providers (APPs) are a critical part of the healthcare workforce since nurse practitioners and physician assistants can carry out responsibilities similar to physicians, including conducting physical exams, prescribing medications, and making referrals.
In the next decade, nurse practitioners and physician assistants will be among the top 10 fastest growing occupations in the country, according to the U.S. Bureau of Labor Statistics.
In part due to a need to increase care access, Sentara Medical Group is planning to double the number of its APPs over the next three years. Sentara Medical Group is the physician group of Sentara Health.
There are three reasons why Sentara Medical Group is seeking to double its number of APPs, says Steven Pearman, MD, vice president and CMO for primary care at the physician group.
"The primary driver of doubling the number of APPs is to increase access to care," Pearman says. "Another driver of increasing the number of our APPs is growth. We do pretty well with established-patient access, but getting new patients in is where the access challenge comes into play."
Finally, Sentara Medical Group is planning to utilize APPs to address a shortage of primary care physicians.
"There is high demand for primary care physicians but a decreasing supply," Pearman says. "We do pretty well in hiring, but it takes a lot of physicians to meet the increasing demand for care, and we can augment the ability of physicians to care for more patients by hiring APPs."
Relying on APPs in the primary care setting is a necessity, according to Pearman.
"In general, there is going to be an increased supply of APPs and there is going to be a declining supply of primary care physicians," Pearman says. "So, relying on APPs is a necessary step if we are going to provide care to the thousands of people who need primary care but do not have access."
Most of the new APPs will be deployed in primary care, where they will have their own patient panels, Pearman explains.
"One of the calculations is that if a primary care physician can take care of 1,500 unique patients, an APP can take care of 1,100 unique patients and two APPs can take care of 2,200 unique patients," Pearman says. "We can leverage APPs to increase our capacity."
Currently, about 50% of Sentara Medical Group's primary care providers are APPs, so there is about a 1-to-1 ratio of APPs to physicians. Pearman says the goal is to get to a 2-to-1 ratio.
Team-based primary care model
Sentara Medical Group is embracing a team-based model for primary care.
One of the goals of the team-based model is to take some duties away from physicians and APPs so they can spend more time on patient care delivery, according to Pearman. For example, the physician group is increasing staffing of a nurse advice line, and medical assistants and registered nurses will be fielding most electronic in-basket messages from patients.
"They want to see patients, but they are burdened by documentation, chart reviews, patient messages, and medication refills and renewals," Pearman says. "If we address those things, we can give physicians and APPs the cognitive capacity and time to take care of more patients."
Under the team-based model, primary care physicians and APPs have a collaborative relationship with defined expectations, Pearman explains.
"Early on in a relationship, even if the APP is experienced, there is close collaboration including physician chart reviews for about six months," Pearman says. "After that, there are select chart reviews."
Physicians serve as "sounding boards" for APPs, according to Pearman.
"We onboard APPs and educate APPs to manage complex issues," Pearman says. "If there is something they have not seen before or something they are unsure about, there is an open-door policy for APPs to go to their collaborating physician."
Another option for an APP is to refer a patient to specialty care, according to Pearman.
"We are rolling out electronic consults, which will provide APPs with an opportunity to ask questions before they refer a patient to specialty care," Pearman says. "APPs usually function as an autonomous primary care physician, with the backup of a physician if needed."
Addressing workplace violence is an important element of the CMO role at health systems and hospitals, this associate CMO says.
Addressing workplace violence is part of a CMO's responsibility to establish a positive work environment for clinical staff.
Healthcare organizations carry a heavy workplace violence burden, with about three-quarters of U.S. workplace assaults occurring in healthcare settings, according to the Occupational Safety and Health Administration. Workplace violence is prevalent in emergency departments—78% of emergency physicians have reported being targets of workplace violence in the prior 12 months.
Workplace violence prevention is an important part of running a hospital with a positive work environment, according to Maya Bunik, MD, associate CMO at Children's Hospital Colorado.
"It is part of making sure that we have a protected environment for our team members," Bunik says. "Addressing workplace violence boosts retention of team members, which is paramount."
Limiting workplace violence is an important part of her role, Bunik explains.
"We need team members to feel that when they come to work it is going to be a positive experience and that their service is going to be appreciated," Bunik says. "We want our team members to want to continue to work here."
Verbal abuse is the most common form of workplace violence in healthcare settings nationally and at Children's Hospital Colorado, according to Shelby Chapman, MA, director of patient-family experience at the hospital. Verbal escalation and verbal violence refers to behavior such as yelling, cursing, and using demeaning language.
In 2018, Children's Hospital Colorado surveyed its staff to see what kinds of workplace violence they were experiencing, according to Chapman.
"That survey in 2018 kicked off our journey toward addressing workplace violence," Chapman says. "It spurred our organization to make addressing workplace violence one of our pillar goals—one of the top-level goals that we focus on."
Workplace violence initiatives
One of the first workplace violence initiatives that the hospital launched was the creation of a safe and healing environment policy, which is promoted with flyers and signs throughout the institution, Chapman explains.
"It outlines the behaviors that we expect from our families and patients when they come into our facilities," Chapman says. "It also talks about how we are going to partner with families."
The safe and healing environment policy is helpful for having difficult discussions with families and patients about disruptive behavior, according to Chapman.
"It is also supportive of our families because when they are in an emotional or heated state, we don't want them to feel they are being singled out," Chapman says. "By having language accessible and on the walls, it helps our families know the expectations for everyone."
Bunik says that hospital leadership gets directly involved in workplace violence incidents, including a communication reconciliation initiative.
"An executive physician leader is on duty for a week at a time to support team members with difficult conversations," Bunik says, "whether it is a disgruntled family or a stressful situation that is hard for the team members to address."
Children's Hospital Colorado has two projects it has launched to address verbal escalation in the outpatient setting.
"Our scheduling teams and nursing teams were experiencing frequent verbal escalations, which was taking a toll," Chapman says.
The first project was a tip sheet to help team members deal with difficult families on the phone, according to Chapman.
"It is a one-page tip sheet on how to de-escalate an upset caller," Chapman says. "Although we have an annual training that goes through some of these techniques, the tip sheet is helpful because it can be hard to remember the techniques in the middle of a difficult phone call."
The tip sheet includes steps for team members to center themselves, advice on acknowledging a family member's emotion and empathizing with them, as well as tips to reach a resolution with a family member.
The other project for outpatient clinics was recording a patient's voice as part of the recording that greets callers, according to Chapman. The initiative originated from one of the hospital's clinics.
"Their idea was to record the voice of one of our patients and have that play at the beginning of a call," Chapman says, "as a way to turn down the temperature and remind the caller of what we are here for."
The hospital is also launching a video initiative to address workplace violence in the emergency department and urgent care center settings.
"In our emergency department and urgent care centers, it can be stressful for our patients and families as well as our team members," Chapman says. "We have recognized that one of the ways to prevent verbal escalation is to address common sources of frustration and to do some expectation setting."
One of the sources of frustration addressed in the video is the triage process. The video explains how the triage processes work and lets families know the care team will be getting to their child as soon as possible.
"In the emergency room, we see the sickest patients first, and that is the opposite of everywhere else you go in your life. Everywhere else, it's first come, first served," Chapman says. "When you are in the ED or urgent care with a sick child, triage can be frustrating."
Children’s Hospital Colorado has joined NRC Health’s workplace violence cohort. This cohort offers the hospital the opportunity to collaborate with other hospitals and health systems on tangible ways and best practices to create a culture of mutual respect and workplace safety.
Physician leadership development needs to be a top priority for health systems and hospitals as well as physicians who are interested in administrative roles, says this CMO.
Physician leadership development is pivotal for the U.S. healthcare system because many of the top-performing hospitals are physician-led.
Recent research shows there is a gap between physician interest in leadership development and opportunities to gain this experience.
A new report from Jackson Physician Search and the Medical Group Management Association found that 67% of physicians surveyed were interested in leadership development opportunities, but only 18% had been exposed to nonclinical leadership development through their education or experience in clinical practice.
It is essential for health systems and hospitals to offer leadership development opportunities, says Kristin Mascotti, MD, MS-HQSM, CPE, CMO of Penrose Hospital, which is part of CommonSpirit Health's Mountain Region.
"It is vital to provide physicians with leadership development opportunities," Mascotti says. "Some of the best-performing healthcare centers and hospitals in the nation are physician-led."
Leadership development is rarely provided in medical schools, according to Mascotti.
"In medical school, trainees believe themselves to be leaders, but they are so focused on clinical expertise that leadership development is rarely a focus," Mascotti says.
Similarly, early career physicians are focused on clinical expertise, and not on leadership development, Mascotti explains.
"When we look at what leadership roles physicians want to take, they want to either be leading within their department or serving on a committee related to their area of expertise," Mascotti says. "They want to lead in areas in which they are comfortable."
At CommonSpirit, there are formal and informal leadership development opportunities for early career and mid-career physicians who have shown influence in their department or on committees, according to Mascotti.
"We offer them a leadership training program, which can go up to a year," Mascotti says. "They develop expertise in leadership as well as finance, and they work on a project."
There are many committees for physicians to get involved in at the health system through the medical staff structure such as the Medical Executive Committee and Credentials Committee.
"It is a great way for physicians to become a part of committees and lead committees," Mascotti says. "We also have our medical staff involved in our Quality Committee, which is important in oversight of quality in the organization."
Finally, there are usually problems to solve in clinical departments, which can be a proving ground for aspiring physician leaders at CommonSpirit.
"These situations provide informal leadership roles that can evolve into formal leadership roles," Mascotti says. "Physicians can find a problem, solve it, then generate results such as lives saved, improved quality, and financial return on investment."
Beyond leadership development opportunities offered at health systems and hospitals, physicians can take the initiative to build their leadership skills. There are certifications for physicians such as a Certified Physician Executive, which is offered through the American Association for Physician Leadership.
"Physicians can benefit from leadership training programs that are six months to 18 months, depending on how quickly they can participate," Mascotti says. "That can then lead to master's degrees."
Physician leadership skills
When you look at the competencies of a great physician leader, the top two are influence and trust, according to Mascotti.
"To be a physician leader, you must have problem-solving and relationship-building skills in order to have great influence," Mascotti says. "You also need to engender trust. If you have those things, you can drive change in a team environment."
When looking at high-functioning teams, the number one capability of those teams is they have mutual trust and respect, Mascotti explains, which makes trust indispensable.
"Trust encompasses things like integrity, ethics, collaboration, and teamwork," Mascotti says. "If you look at engagement overall, it boils down to trust."
Additionally, Mascotti recommends that physicians who are interested in serving as CMOs seek out formal and informal leadership development opportunities to show that they can make an impact and influence others along strategic priorities.
"Most CMOs will require an advanced degree such as an MBA or MHA," Mascotti says. "I tell people who want to be a CMO to solve a problem and get involved in committees."
Mascotti, who served as CMO of NCH Healthcare System in Florida before joining CommonSpirit, pursued informal and formal leadership development opportunities along her path to becoming a CMO.
"First, I leaned into problems that needed to be solved in my department. From there, I had no dearth of projects to work on. The projects just got larger and larger," Mascotti says. "Then I got my Certified Physician Executive certification and went on to get my masters of science in healthcare quality and safety management degree."
Mascotti also recommends that aspiring CMOs get the Certified Physician Executive certification.
"You get exposed to things that you did not learn in medical school or early in your career," Mascotti says, "such as looking at your own emotional intelligence, finance, quality, and managing performance."
Setting clinical standards boosts patient safety and care quality, says this physician leader.
One of the primary focal points for the inaugural chief physician executive officer at CommonSpirit Health will be reducing variation in clinical care.
Thomas McGinn, MD, MPH, was appointed as senior executive vice president and chief physician executive officer of CommonSpirit in September. He joined the health system in 2021 as executive vice president for physician enterprise, where he oversaw physician and advanced practice provider employment and alignment models with accountability for advancing clinical integration and population health management.
McGinn says he is passionate about reducing clinical care variation to boost patient safety and quality.
"My background is in evidence-based medicine and looking at clinical standards," he says. "We have a national program that sets clinical standards."
According to McGinn, the key to success in setting clinical standards is to have clinicians drive the process.
"It is not a top-down approach," he says. "We put the standards in front of the clinicians, we give them some options, we have multiple group meetings, then the clinicians come to a consensus about the clinical standards."
The process also involves bringing together clinicians and thought leaders from academic and non-academic facilities drawn from across the health system, McGinn explains.
"We have a support system as we pull the working groups together to give them the latest evidence," he says. "There can be three different groups of 20 people each who are multidisciplinary. We summarize their final conclusions."
Once a clinical standard has been set, CommonSpirit promotes widespread adoption, according to McGinn.
"We educate our clinicians about it. We have internal grand rounds. We have podcasts. We have seminars," McGinn says. "We then look at whether there is an opportunity to embed a clinical standard in the electronic medical record. We follow the data on the impact of a clinical standard, and we keep the clinical standard workgroups in place for about a year."
Thomas McGinn, MD, MPH, is senior executive vice president and chief physician executive officer of CommonSpirit Health. Photo courtesy of CommonSpirit Health.
Capitalizing on size and scale
In his new role, the biggest challenge and opportunity for McGinn will be taking advantage of CommonSpirit's size and scale.
CommonSpirit is one of the largest health systems in the country, with more than 2,200 care sites in 24 states, more than 35,000 providers, and 45,000 nurses.
Where some people see a challenge in managing such a large health system, McGinn sees it as an opportunity to leverage size and scale as well as increase efficiencies.
"We are the largest population health, value-based care provider in the United States. We are also one of the largest Medicaid providers," McGinn says. "We have been combining offices and putting them under one national roof to create centralized expertise on data analytics and technology."
The supply chain impact of Hurricane Helene is an example of how CommonSpirit can benefit from its size and scale.
"The recent Baxter IV fluid shortage hit some of our California, Phoenix, and Las Vegas areas," McGinn says, "but we didn't even feel it because we were able shift fluids from the Midwest. So, size and scale have become a real advantages for us."
As another example, CommonSpirit used to have many ways of answering phone calls with different technology, which the health system has moved to consolidate.
"Over the past three years, we have switched to one centralized connection center with four hubs," McGinn says. "We have reduced our costs and increased our efficiency."
McGinn says he has an opportunity to influence care on a grand scale.
"My new job crosses the continuum of care from primary care to specialty care to acute care to intensive care, so I have a lens on all kinds of care," McGinn says. "The opportunity for me is to connect the dots, so patients have a positive experience in the continuum of care."
Dyad partnership
McGinn will be working in a dyad partnership with CommonSpirit's CNO, Kathleen Sanford, RN, DBA, MBA.
Being a dyad partner has two primary elements, McGinn explains.
"One is you are joined at the hip on your decision-making processes," McGinn says. "Each dyad partner knows what the other person is doing and there is no separate decision-making. You run your own workflows, but people see you standing next to each other all the time."
The other aspect of dyad partnerships is the focus on shared platforms. Currently, McGinn and Sanford are prioritizing wellness and career development.
"Kathy and I are going to share a platform for that work," McGinn says. "We are going to have a shared platform that manages talent development, wellness, and educational activities."
Another area of focus for McGinn and Sanford will be patient satisfaction.
"We have a large, centralized service of expertise and a singular way of measuring patient satisfaction across every type of clinical site," McGinn says. "Whenever we see dips in some areas, we can deploy evidence-based patient satisfaction teams."
McGinn cites the example of when CommonSpirit had a market where there was a decrease in patient satisfaction at ambulatory sites.
"We deployed a patient satisfaction team to that market for a week," McGinn says, "and they helped the physicians, nurses, and staff with everything from simple training on eye contact and greeting patients as they walked into clinics to more advanced approaches to patient satisfaction."
Virtual nursing has also been a major initiative to improve patient satisfaction in the inpatient setting, McGinn explains.
"To address nursing shortages at our hospitals, we have been deploying virtual nursing to relieve some of the administrative work that is not patient-facing," McGinn says. "That has enabled the bedside nurses to be more engaging with their patients."
The steps necessary to address health equity gaps include harnessing data and monitoring the impact of interventions.
To address health equity, a health system or hospital needs to have intentionality about identifying gaps in care and closing those gaps, the new CMO of University of Chicago Medical Center says.
Tipu Puri, MD, PhD, was appointed as CMO of University of Chicago Medical Center last month. He joined UChicago Medicine as an internal medicine resident in 1999. Puri has held several physician leadership roles at the academic health system, most recently serving as associate CMO.
To address health equity concerns, a health system or hospital must be inquisitive, according to Puri.
"It starts with asking questions about health equity," Puri says.
The next step is harnessing data, Puri explains.
"You need to have data that you can act on," Puri says. "Our data and analytics team has done a good job of creating an equity lens that we can use when we look at any of our data and break data down along multiple patient demographics, including race, gender, and Zip codes."
Finally, a health system or hospital must decide how to address a health equity gap, according to Puri.
"If we see gaps, we ask, why do those gaps exist and how can we intervene?" Puri says. "Then you need to monitor whether the things you are trying to do to close a gap are working. Are you seeing the gap in care closing? We want our patients—regardless of who they are and where they come from—to have the same outcomes."
According to Puri, University of Chicago Medical Center closed a health equity gap in blood pressure management, with a disparity between Black and non-Black patients. It started with identifying that the medical center was not meeting the targets with the Black population, then leaders asked why the medical center was not meeting its targets.
"To close the blood pressure management gap, we implemented programs such as remote patient monitoring and pharmacy-assisted blood pressure management," Puri says. "Then we monitored the data to see that the difference in patients meeting the targets and outcomes were no longer different between racial and ethnic groups."
Tipu Puri, MD, PhD, was appointed as CMO of University of Chicago Medical Center last month. Photo courtesy of UChicago Medicine.
Biggest challenge
University of Chicago Medical Center serves an urban patient population, and according to Puri, the biggest challenge in serving that population is providing access to care.
"There is a significant need in the community that we serve, and a high burden of chronic disease," Puri says. "Maintaining access to our patients through our ambulatory clinics, emergency department, and specialty care programs is a challenge."
In the inpatient setting, maintaining access to care for patients requires the efficient use of resources, Puri explains.
"That generally focuses on looking at avoidable delays, improving the timeliness of care delivery, improving the planning for patient discharge, and improving medical decision-making," Puri says.
In terms of discharge planning, Puri says the medical center has completely restructured its care coordination team to maximize their coverage of patients, cross-train them, add resources and staff, and lower patient-to-care-coordinator ratios.
"We do care coordination assessments within the first 24 hours after patient admissions," Puri says. "We identify needs that may come up at discharge and identify social determinants of health that we might be able to address."
Mentorship responsibility
As CMO, one of Puri's roles will be to provide mentorship to physician leaders and frontline clinicians, and a big part of mentorship is providing empowerment and support to physician leaders.
"They need to feel empowered to implement solutions," Puri says. "The decision hierarchy and the command chain need to be simplified where they can be simplified. If they have a solution, they should feel empowered to run with it."
A mentor should be able to challenge physician leaders when necessary, Puri explains.
"Sometimes, mentorship involves challenging physician leaders if we are not meeting the targets and the goals we have set for ourselves or if we are not providing adequate access to care," Puri says.
To provide mentorship for frontline clinicians, accessibility is crucial, according to Puri.
"A CMO should be seen," Puri says. "There should be opportunities for hallway conversations. It can be random rounds on the wards. It can be sitting in lounges or being seen in the food service areas."
A mentor must also be approachable, Puri explains.
"If frontline clinicians have an issue they want to talk about, they should feel comfortable coming to you to talk about it," Puri says. "By being accessible and approachable, that is where we are going to get our best information to act on."
Interdisciplinary care team success
The most important factor for success of interdisciplinary care teams is communication, according to Puri.
"As leaders, the best thing we can do is make that communication as easy as possible," Puri says. "It can be as simple and pragmatic as putting offices or workrooms close together. It can be encouraging multidisciplinary rounds to happen at a nursing station, so the nurses can more easily join the session."
Sometimes, CMOs and other physician leaders need to enforce communication among members of interdisciplinary care teams, Puri explains.
"You need to challenge care teams when communication has not been as good as it needs to be," Puri says. "You need to tell an interdisciplinary care team that they need to be better because our patients are counting on it."
In partnership with Columbia University Irving Medical Center, NewYork-Presbyterian is developing an AI tool for the early detection of cardiovascular disease.
NewYork-Presbyterian is involved in a unique effort to develop an artificial intelligence tool for the early detection of cardiovascular disease.
HealthLeaders is conducting its AI in Clinical Care Mastermind program through December. The program brings together nearly a dozen healthcare executives to discuss their AI strategies and offerings.
One of the advantages of NewYork-Presbyterian is that it is affiliated with two medical schools, Columbia University Vagelos College of Physicians and Surgeons as well as Weill Cornell Medicine, says Ashley Beecy, MD, medical director of AI operations at NewYork-Presbyterian.
"There are research teams across the enterprise developing AI models and working on translational research to bring the models to point of care," Beecy says. "They also conduct clinical trials to understand both the factors for the safe use of AI and the efficacy of the models when integrated into the healthcare system."
A team comprised of clinicians and researchers from Columbia University Irving Medical Center is developing an AI tool for the early detection of cardiovascular disease.
"There is a lab at Columbia, CRADLE (Cardiovascular and Radiologic Deep Learning Environment), led by Dr. Pierre Elias, doing incredible work looking at different types of cardiovascular data for early detection of disease," Beecy says. "For example, an AI tool can use electrocardiograms (EKGs) to identify potential markers for structural heart disease that a cardiologist reading an EKG can’t identify with the naked eye. Depending on the score the AI model generates, it will prompt a cardiologist to order an echocardiogram to confirm diagnosis."
Additionally, NewYork-Presbyterian’s Enterprise Heart Failure Program, led by Dr. Nir Uriel, with physicians from its affiliated medical schools, is collaborating with Cornell Tech and the Cornell Ann S. Bowers College of Computing and Information Science to transform cardiovascular health and heart disease prediction and prevention using AI and machine learning.
Ashley Beecy, MD, is medical director of AI operations at NewYork-Presbyterian. Photo courtesy of NewYork-Presbyterian.
Assistive AI tools
In addition to the innovative cardiovascular disease detection AI tool, NewYork-Presbyterian is rolling out several assistive AI tools that are impacting clinical care, according to Beecy. A few examples include:
Ambient scribe: This AI tool has been focused on the outpatient setting. The tool transcribes a conversation between a clinician and a patient, then generates a draft clinical note to document the interaction. "One of the interesting findings so far is that ambient scribe is saving a few minutes for clinicians, but when you survey them, clinicians feel strongly that ambient scribe reduces their documentation time," Beecy says. "This reflects changing documentation from a writing task to an editing task, which reduces the cognitive load."
Risk prediction: NewYork-Presbyterian is using an AI tool that alerts nurses about potential fall risk for inpatients at the health system's Lower Manhattan Hospital. "We are getting feedback from nurses on whether they find the AI tool's alerts useful and whether the alerts are preventing falls," Beecy says. "We want to work closely with nursing teams as stakeholders to ensure that the AI tool's alarms are not interrupting their workflow. We want to make sure it is augmenting their work in a positive way."
Radiology: The health system is using an AI tool to triage radiology images. One example is the use of AI for identification of stroke, including possible intracranial hemorrhage. The goal is to notify care teams for early intervention.
In-basket messaging: This is one of the first AI tools adopted at NewYork-Presbyterian, and it helps clinicians respond to patient questions in their electronic in-boxes. "It is very similar to ambient scribe," Beecy says. "People feel as though it is saving them time since the task moves from writing to editing. The metrics for time savings are variable, and it will be interesting to see whether the in-basket messaging tool reduces clinician burnout over the long term."
For each assistive AI tool, there is still a human in the loop, Beecy assured.
"There is a team member who is responsible for reviewing what AI tools are generating and making sure the information is correct before submitting it," Beecy says.
AI's impact on clinical care teams
For clinical care teams, right now AI is something unique and independent of the way clinicians currently practice medicine, Beecy explains.
"In the long term, we are going to find that AI becomes ubiquitous in the way we practice medicine," Beecy says.
In the short term, the focus of AI tools in clinical care at the health system is on administrative tasks and diagnostic accuracy, according to Beecy.
"This allows us to focus on the human input and the patient interactions for care processes, without radically changing how we work," Beecy says.
Over time, more data will be digitized and transformed into useful data sets that can be harnessed by AI tools, Beecy explains.
"We will generate insights from this data such as wearables and digital pathology," Beecy says. "AI systems will become more of a part of our decision-making process, and we will see more algorithmically guided care."
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Part of being a health system or hospital CMO is working hand-in-hand with the organization's chief financial officer.
CMOs have a role to play in financial stewardship at health systems and hospitals, the new CMO of Christ Hospital Health Networksays.
Marcus Romanello, MD, MBA, started working as vice president for medical affairs and CMO of Christ Hospital Health Network on Oct. 1. He was most recently CMO of Kettering Health Hamilton, a hospital in Hamilton, Ohio.
Christ Hospital Health Network features The Christ Hospital, a 555-bed nonprofit facility in Cincinnati.
Financial stewardship and high-quality clinical care are intertwined, according to Romanello.
"Financial stewardship harkens back to the concept of any healthcare organization that delivers clinical excellence in a compassionate manner will never want for customers," he says. "If you keep your eye on the goal of delivering the best possible clinical outcomes, oftentimes, the financial pieces will quickly fall into place."
CMOs need to help control costs, Romanello explains.
"As CMO, I am frequently working side-by-side with the chief financial officer of the organization looking at ways in which we can elevate our care but do so in a cost-conscious manner," he says.
CMOs can contribute to financial stewardship by having a hand in the acquisition of the products and supplies used in clinical care settings, according to Romanello.
For example, there can be product choices in the operating room environment, where there may be several options available to the surgeon to choose between products that have equivalent outcomes. "The CMO needs to help the surgeon understand there are cost differences, and their selection of a product has an impact on the bottom line," he says.
Implants are another area where a CMO can help a health system or hospital contain costs, Romanello explains.
"With a knee-replacement implant, one particular brand may be two times the cost of another brand," he says. "Oftentimes, those price differences are not well described to the surgeon. So, the CMO can help them become aware."
At healthcare organizations, resources are finite, and CMOs can present valuable information to clinicians that supports financial stewardship, according to Romanello.
"A CMO can promote financial stewardship through bringing cost data to the table, so that it can be considered," he says.
Marcus Romanello, MD, MBA, is vice president for medical affairs and CMO of Christ Hospital Health Network. Photo courtesy of Christ Hospital Health Network.
Service line success
For CMOs, a primary consideration in the success of service lines is working to ensure that there are effective hand-offs of patients between service lines, Romanello explains.
"When we look at the integration of healthcare delivery models, service line architecture often breaks down during hand-offs of patients between service lines," he says. "It is important for the CMO to visualize these hand-offs and make the bedside physician or other members of the care team within a vertical service line aware of hand-offs and make sure they go seamlessly."
Romanello cited the example of a patient with debilitating knee pain.
If the patient is seen in the outpatient setting by a primary care physician, that clinician could refer the patient to the musculoskeletal service line for physical therapy. There may be imaging to diagnose the problem, and, ultimately, the patient could be referred to an orthopedic specialist.
"For each of those hand-offs, there is the risk of incomplete communication. It is important to integrate the service lines, including the primary care service line and the orthopedic service line in this case," he says. "When a hand-off occurs, you want to make sure that information is not lost and the aims of the treatment are not lost."
A CMO plays an essential role in service line success, according to Romanello.
"A CMO should ensure that each service line has clearly identified their metrics for success so service lines can maximize the value of the care delivered to the patient," he says. "Any referring physician or customer seeking out services needs to be confident that they are getting the absolute highest level of quality. That drives the business."
Key metrics for service lines include hospital length of stay, complication rate, mortality rate, and how soon after discharge patients are following up with a physician to ensure everything continues to go well, Romanello says.
Artificial intelligence and clinical care
Artificial intelligence is on the cusp of becoming an essential component of clinical care, Romanello explains.
"AI will never replace a physician, but physicians who use AI will likely replace those who don't use AI," he says. "The volume of data surrounding healthcare has ballooned to the point where it is difficult for any one individual to fully assess data. That is where the AI models can help us better calculate patient risks, better calculate the optimal treatment strategies for patients, and expand our capacity to care for patients."
Romanello has worked on AI initiatives in clinical care before coming to Christ Hospital Health Network.
"For example, I have previously been involved in projects where we have looked at using AI to digest the entirety of a patient's chart to look for all medical problems, both active problems and historical problems, so those problems can be brought to the attention of the treating physician," he says.
Romanello plans to be involved in AI initiatives at The Christ Hospital.
"I am interested in the interface of technology and healthcare," he says. "In the coming years as we integrate AI models into care delivery here at The Christ Hospital, we are going to elevate the level of care we are giving."
Thomas McGinn, MD, MPH, is senior executive vice president and chief physician executive officer of CommonSpirit Health. Photo courtesy of CommonSpirit Health.
Tipu Puri, MD, PhD, was appointed as CMO of University of Chicago Medical Center last month. Photo courtesy of UChicago Medicine.
