Typical Projects for the Hospital Executive

Today I will describe my experiences with the assignments of a hospital CMO. These are based on my 14 years as a senior hospital executive. There was a lot to like about that job, with lots of fond memories. More than I can cover in one podcast episode.

But today, I’ll focus on some of the specific projects I worked on and the directors I worked with. I think it will give you a better idea of what a CMO does. And I hope it will inspire you to consider a hospital management career.

For those NOT considering such a career, you should listen anyway, because what I’ll describe applies to a senior leadership position in almost any industry – even in your own business.

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6 Assignments of a Hospital CMO

In this episode, I will describe in detail my experiences with typical assignments of a hospital CMO, including:

1) Leading the CME program, supporting the residency program start-up, and working with Lisa Zipsie, Director of Physicians Services.

2) Selecting and implementing the first Quality Management Tool, achieving Top 100 Hospital Status, and working with Mary Schore,  Director of Quality Improvement.

3) Implementing the hospital’s first Lean Process Improvement Initiative and working with Stephanie Mitchell, Director of the Lean Process Improvement and Laboratory Services.

Each CMO in any given organization will fit into the org structure in a unique way. – Dr. John Jurica

4) Overseeing the implementation of physician order entry, the medication safety program, and working with Jim Shafer, Pharmacy Director.

5) Establishing the first hospitalist service.

6) Recruiting physicians, purchasing local physician practices, and expanding the medical group to become the dominant multispecialty group in the county.


That’s a glimpse into the life of the CMO, and a sample of my assignments while in that role. It was exciting, challenging, and impactful. The CMO in each organization will fit into the org structure in a unique way, with different direct reports and areas of responsibility.

In the hospital setting, they will usually have QI and Patient Safety, Physician Services, and CME (if there is a CME program). But beyond that, it can vary considerably.

In a future episode, I will share more about the day-to-day work of the CMO, and what it is like working with a senior executive team at a not-for-profit hospital.

NOTE: Look below for a transcript of today's episode.

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Transcription PNC Podcast Episode 218

6 Important Assignments of a Hospital CMO

All right, Nonclinical Nation, today I thought I would discuss my work as chief medical officer. I spent 14 years as a senior VP at my hospital, and there was a lot that I liked about that job. Actually, much more than I can cover in one podcast episode. I already spoke to you way back in episode number 20, about the positive aspects of hospital management that I think you should consider if you're looking for a nonclinical career.

But today I'm going to focus on something a little different. I'm going to talk about the specific projects I worked on and the directors I worked with while I was chief medical officer. And I think this will give you a better idea of what a CMO does and how enjoyable the work can actually be. And I'm hoping it will inspire you to consider a hospital management career.

Even for those not considering such a career, you should listen anyway, because what I'll be describing applies to a senior leadership position in almost any industry, certainly many healthcare industries such as pharma companies, medical device companies or the insurance industry, but even in your own business in other non-healthcare related fields.

I think I'm going to come back again on a future episode where I'll focus on the other aspects of the job, such as what it's like to work as a member of a senior executive team. The so-called C-suite. That will be interesting as well.

For today, I'm going to just focus on six assignments that I had over my career as a hospital chief medical officer. And really in some ways, it's just scratching the surface. Although the areas that I'm going to be talking about today are definitely areas that I was involved with for almost my entire career, while I was CMO with a couple of them coming in later in the final 5 to 10 years.

Now, for two of the six, there is definitely no distinct director to mention for reasons I'll explain when I get to those assignments, but the other four definitely include working with the director for the whole term of my employment there and sort of how we work together on these major projects that I'm going to highlight during the rest of today's discussion.

Let me just give you the list of the six assignments right now, and then I'll go into them in more detail individually. Number one is leading the CME program and supporting the residency programs startup and other things related to physician services, which was led by the director of physician services, Lisa Zipsie.

The second is selecting and implementing the first quality management software program and achieving top 100 hospitals status while working with Mary Shore, the quality improvement director.

The third is implementing the hospital's first lean process improvement initiative and working with Stephanie Mitchell to help the lab expand and improve its services. She was the director of the laboratory services department, and she recently retired.

Number four is overseeing the implementation of physician order entry and medication safety programs at the hospital while working with the pharmacy director, whose name is Jim Schafer.

Number five was establishing the first hospitalist service. Now there wasn't a particular director that handled that with me. I was the lead on that, and I had to work with various departments at the hospital to get that project up and going. And so, I'll describe that.

And the number six is something that I took on during the last four or five years of my tenure, which was the multi-specialty group. I spent a lot of time in those years recruiting physicians, purchasing local physician practices, doing all the negotiation, all the contracting, and working with the attorneys. And again, there was no individual director that helped lead that, but I had to work with a number of directors over the areas that impacted or were impacted by the growing group, including the facilities department, which had to find space for us.

You may have already noticed that all of these activities involve big projects that have a direct impact on the safety and quality of patient care and the financial success of the hospital.

In all of the projects, I will describe where major initiatives straight out over our annual strategic planning and management goal-setting process. We did that every year. We began by developing a set of goals for all 80 plus directors and VPs running the hospital. And some of them span more than one year if they are especially costly. But that's what drove us to do what we did.

Also from a process standpoint, the way that these goals were met, generally involved me and other VPs sitting on committees and teams addressing the initiatives, meeting with our directors regularly and keeping forward progress. We'd receive updates on their progress, provide them with feedback, lend them support by shifting resources from one area to another one that was needed.

My other role, doing all of this, also involved helping each director who reported to me to prepare a yearly operational budget that we would present and defend to the CFO and COO.

There was also a capital budget with requests for major and minor equipment. And this could include everything from a multimillion-dollar information system, let's say for the pharmacy to new carpeting for the medical staff lounge. And every year everybody had their requests. And of course, there was a cap on the capital that would be spent. So, we had to demonstrate why ours was worth funding.

Now, the other side of that coin is that I was then responsible for reporting back to the CEO and to the senior management team in our weekly meetings on the progress being made on the management goals that we had all agreed upon at the beginning of each year. Let me get into some of the specifics and I'll start with number one, leading the CME programs, supporting the residency program startup, and working with the director of physician services.

This is normally a core responsibility, the CMO, because we interact so directly with the medical staff through its governance, through facilitating and supporting the medical staff structure. But we had a CME program. I was the chair of the CME committee, even before I became employed by the hospital. I continued in that role.

And so, if you have a CME program, then you're probably going to have it fall in this area and maybe standalone. But oftentimes, it's under the medical staff department.

We were responsible in the committee and under this director for maintaining our accreditation as a CME provider. And of course, all the credentialing and staff appointments were done by this department.

Now, late in my tenure, it was decided by the senior team and particularly the CEO was interested in doing this, was to help us with our recruitment of physicians, which seem to be getting more difficult every year by adding an internal medicine residency and fellowships in GI and cardiology. Those were added in part to help drive people to come to the IM residency because then they would have a slight advantage at getting into one of the fellowships, which were definitely very popular.

Now we were not an academic institution. We had affiliations with some institutions, one of which Rush University Medical Center, and particular of course is an academic medical center. But we chose to align with an osteopathic medical school. We were able to get our internal medicine residency and fellowships going through them. And of course, now all of those are going to be blended into one entity under the ACGME. That was fun. That was great. That was part of my core responsibilities for many years.

The second big project and an area that I had responsibility for was quality improvement. And it was one of the things that I really wanted to be sure was happening when I joined back at the beginning of my tenure there, was to be sure that we had a tool to measure risk-adjusted complication rates, mortality rates, quality measures that we could then share with the medical staff and monitor our progress and making improvements in quality and to some extent patient safety.

That was one of my first projects. I had a chance to look at what was available then, and we purchased a tool that was very effective and gave us some really good results that we could share with the medical staff individually and as groups or departments.

By using tools and creating protocols and teams to address any quality issues that we identified, we were able over a period of time, along with help from the CDI department and utilization management become a top 100 hospital. Because to do that, you must have really good measures in your quality metrics, you also have to have a good financial standing and good length of stay. All of that also depends on excellent coding and documentation.

So, just like in management, you manage what you measure, also in QI and patient safety, you manage what you measure. When other tools came out later, we actually adopted some of those as well because they were a little easier to use. And then we started working with other organizations to combine our data so that we'd have a larger pool to compare outcomes to.

Over a period of time that led us to achieve top 100 hospital status. I think it was originally through Solution and then Truven, and now I think it's under a new moniker, but we had five or six years in which we achieved that. And that was very rewarding. Again, that was through the help of the QA director, Mary Shore, and others in her department.

The third big area is the laboratory. I worked with Stephanie Mitchell, the director of laboratory and lean process improvement. That was the most exciting project that we did. Now I had a laboratory the entire time I was there. It was obviously very important that we had a lab that was efficient, that was accurate, that had good turnaround times. And so, that was the first lean project we ever took on at the hospital. It was one that was really typically geared for laboratories. There is always a very good one that could benefit from streamlining and changing from a batch process to a sort of continuous flow process.

And so, we learned how to do lean performance improvements. We implemented that. We got our routine lab results to a point where they were being returned within 30 to 40 minutes, no matter what time of day or night that they were ordered. And it was awesome. It also helped a lot, obviously with the quality improvement projects that I mentioned earlier. So again, a very rewarding project.

We moved on to other departments, including the pharmacy to do some lean projects. And so, that's the next one, number four, that I want to mention. I did have the pleasure of having Jim Schaefer, the pharmacy director, report directly to me for my entire term at the hospital. We work mostly on improving medication safety.

Although we also had to be certain that we kept our formulary up, that we had access to the drugs that our physicians needed and that we can keep the costs down.

In other words, you can't necessarily stock 10 different versions of the same medication. You usually have to pick one or two. And it does lead to some problems when patients are being admitted and discharged, because they may be on a medication, a different version of the medication that you've gotten your formulary in, and you have to make those substitutions, which can be difficult.

But the best projects that we did we're eliminating essentially many forms of medication errors resulting from physician handwriting by basically implementing a mandatory physician order entry, which meant that everything had to be built. And once it was built and implemented, physicians go order their labs and their meds. And the issue of someone having to read the handwriting was almost completely eliminated. There were some instances where people might send in written orders that had to be transcribed, but we pretty much eliminated that.

I think it's great when the CMO and the director of the pharmacy worked together because the pharmacy and the others I've mentioned so far, really have a lot of clinical implications without having to stretch the imagination. They have direct clinical implications and of course, medication safety also improves the quality, which also helped reach that top 100 status.

Now, the fifth project I want to talk about is the establishment of the first hospitalist service. And this is not something that the hospital medical staff came to us and requested. In fact, it was one of those things that they probably didn't really want to see. They really weren't ready for it, but we had so much data showing that the performance at other hospitals was improving so much. And that particular delays in care could be avoided if we had an on-staff in-house hospitalist service that we decided to implement.

I had to communicate that to the medical staff, of course. I think I sent a recent email out about that process. And we had to figure out how to staff it and how to bridge that gap from going from none to what we felt we needed at the beginning was at least six plus somebody to cover vacations. So, we struggled with the idea of whether to hire our own. The problem there is if you hire someone, but you don't have a hospitalist service to put them into at the moment, then how do you pay them for not working? How do you keep them waiting while you're trying to get the rest of your team together? So, we decided after looking at the options to contract with an established group, which was nationally doing what we needed and had a very strong recruitment arm, and then we designed the way it would be modeled.

And I did most of the work on the contract with the group, again, working with the attorneys and the CFO. And ultimately, we were able to get that off the ground. It's been very successful. It has morphed over the years to different groups and different staff.

The other thing is the planning meetings that we were using to develop the program, morphed into management meetings with the medical director and others involved and seeing to it that the hospitalist service was efficient. It was prompt and had good outcomes.

Finally, something I got involved with for the last four or five years of my tenure, which you would think maybe I would have been involved with earlier, was the medical group. The thing was we had a small group. They were very independent. And so, they weren't really treated as a group. They were more or less treated as individual small practices in some of the outlying towns. Maybe one or two actually near the hospital itself.

But once we made a strategic decision to expand the group and add other specialties that were lacking in the community, then we really tried to find some super-qualified directors to run that process. However, we went through two or three, and at some point, the CEO thought, "Well, I'm going to have John take it over. We'll continue to try and get a director to work under John. But in the meantime, we can get things moving". And so I went on a binge, so to speak of hiring new physicians and of purchasing current practices, usually, they were one-, two-, or three-person practices, did a lot of contracting, a lot of employment agreements and renegotiating of contracts. I learned a lot.

And over time we added a lot of new staff, new physicians, many specialists that were not previously on the staff. And we also expanded the group geographically to a much larger area where we could help patients.

Well, I think I'll call it quits at that point. I think I've given you somewhat of a glimpse into the life of the CMO. It's kind of hard to separate the day to day from the project-oriented activities. Although I think in a future episode of the podcast, I'm going to talk about the day to day and how I interact with directors on the one end and on the other side, how I reported up to the CEO and the kinds of reports and discussions that we had as well as the regular meetings of the senior executive team, which usually were at least once a week and how we did some strategic planning and also did operational activities in that process. But that'll be for another episode.

I think it's important to acknowledge and remember that each CMO in any given organization will fit into the organization structure in a unique way with different direct reports and different areas of responsibility.

While what I've discussed today applies to many chief medical officers, if you're in hospital management and you get to that point where your CMO or chief integration officer or chief safety officer or anything like that, you're going to have different direct reports and different responsibilities.

But for most of my tenure, everything rolled up into what we called the medical affairs division. And sometimes I had to go to the nursing home. Sometimes they had home health. Sometimes I had the radiology department. The ones I talked about today are most of the core that I had ongoing. But I had to back off a little bit, particularly when I became very involved with the multi-specialty group.

In a hospital setting, usually you're going to have QA and patient safety, physician services, and CME, if you have a CME program, but beyond that, it can vary considerably.

All right. Thanks for listening today and I hope you've enjoyed it. If you have any questions as usual, just reach out to me at john.jurica.md@gmail.com.


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