In this episode, I respond to a listener's question about pursuing a career in quality improvement. Her ultimate goal is to become a chief medical officer for a health system. I list the tactics I would use to achieve that career goal.
Before I jump into today’s content, I need to tell you about a new “how-to-guide” I’ve written. It’s a 24-page manual, complete with checklists for 5 nonclinical careers. It outlines the steps you can take to pursue a career in utilization management, clinical documentation improvement, informatics, medical writing, and hospital management as VP for Medical Affairs.
I wrote it based on my personal experiences, and what I’ve learned doing interviews for this podcast. I was thinking of selling it on Amazon as a Kindle Book. But for now, it’s completely FREE for listeners to this podcast. To download your copy, just go to Free Career Guide.
A Listener's Question
I was on a phone call the other day, talking with a physician listener interested in exploring a new career. She was working as a gastroenterologist in a fairly large medical group and had become involved in quality initiatives at her local hospital.
Let’s call her Nina.
She didn’t have a formal leadership role in the hospital or medical group, but she really enjoyed working on quality improvement projects. And she wanted to explore a career in quality improvement.
She was thinking that she might ultimately want to work as chief quality officer at a hospital or a large group. And, she asked me how to best pursue such a career.
I thought you’d like to hear the advice I gave her, so I’m presenting that today. But first, let me give you a little more information about this relatively new senior hospital executive position.
A New Position: Chief Quality Officer
As hospitals have begun to shift from volume- to value-based care, someone must be responsible for collecting and submitting data needed to demonstrate the organization's quality. And there are multiple processes, tools, and departments that must coordinate their efforts to make that happen.
Let me point out some of the duties of the CQO:
- Implementing quality improvement measurement tools that can provide risk-adjusted outcome measures;
- Implementing a tool that will cull clinical data for the purpose of reporting to CMS;
- Writing and implementing a quality improvement plan that addresses all QI activities, such as
• physician peer review,
• chart reviews for quality monitoring,
• implementing mandatory quality initiatives, such as those for central line infections and DVT prophylaxis,
• initiating QI projects using QI models such as PDCA (plan – do – check – act),
• performing root cause analyses for serious errors or sentinel events;
- Monitoring public reporting (Hospital Compare, HealthGrades, LeapFrog, Truven Top 100 and others);
- Hiring, directing and evaluating the director of QI department and often the Patient Safety Department; and,
- Developing and promoting a culture of safety and quality.
I described my vision of the ideal QI program in Building a Great Hospital Quality Improvement Program.
I’ve seen tremendous growth in this field. This is primarily because CMS is penalizing hospitals financially that don’t meet quality, safety, length of stay and readmissions benchmarks. So, it now makes sense to invest 200- to 300-thousand dollars to avoid paying millions of dollars in penalties. And a CQO will promote quality of care and the hospital’s rankings and reputation.
Suffice it to say that there is a growing demand for physicians who meet the qualifications needed to lead hospital quality efforts.
My Roadmap to Chief Quality Officer
As I thought about her situation, there were several ideas that came to mind, and I shared those with her. Thinking more about the question later, here is what occurs to me:
In general, there is a pretty standard approach to shifting from a strictly clinical career to one in hospital administration, including a role as CQO. It involves these basic steps:
- Overcome mindset issues
- Demonstrate commitment
- Utilize mentors
- Obtain unpaid real-world experience
- Get formal education
- Acquire certifications and degrees
- Obtain formal or paid experience
- Actively pursue a CQO position
It’s sometimes possible to skip a step or rearrange the order. Some clinicians are thrust into a formal, paid position out of necessity and have to address multiple steps concurrently. Some physicians may obtain an advanced degree, such as an MPH, while completing medical school, not realizing it will help them in the search for a CQO job later. But most of us need to follow the steps I’ve outlined.
And there are tactics along the way that help accelerate the process, like joining appropriate associations, obtaining coaching, and networking.
I’ve previously discussed the issue of mindset and self-limiting beliefs with at least two of my guests – (Episodes 10 and 18). Nina had already overcome that barrier. She was really excited about quality improvement and knew it was something she’d be good at.
2. Demonstrate Commitment
In the hospital setting, in order to be involved in formal and informal QI projects or standing committees, those in charge must understand that you have both interest and expertise. In an absurd example, the president of the medical staff is not going to recommend someone in the finance department to work on quality initiatives due to lack of both of these attributes.
Physicians already have the necessary expertise to get started. We know medicine, epidemiology, statistics, and basic infection control and quality improvement principles. But unless someone in a leadership position knows we’re interested, they won’t seek out our help.
Our interest can be demonstrated in only 2 ways: what we say and what we do.
In my conversation with Nina, I started by asking her if she had talked to the director of the Quality Improvement Department at her hospital. She had not. I told her the director would be the person who'd have the most information about the quality improvement enterprise there.
If there was a chief quality officer, she'd know who that person was, and she'd also know which physicians had been most active in the quality initiatives. If there's no chief quality officer, there might be a medical director or two that were involved in certain projects.
And during that conversation, of course, Nina would tell the director that she was interested in working on QI projects, even if they did not involve her specialty. She’d also express this interest to the chair of her department and to the chair of the QI Committee and the president of the medical staff.
She’d also have a conversation within her medical group, to the extent there was a formal QI department or team.
Finally, she’d really demonstrate her interest by consistently attending the meetings, and contributing her input and time to the projects she was working on.
I told her that based on those conversations, it should be possible for her to identify a mentor or two to begin speaking with. The Director of Quality, generally a nurse with special training, could be one of her non-physician mentors.
The best mentor would be a physician already deeply involved in quality, such as the CQO or medical director for quality. Remember, the typical mentor is generally a step or two ahead of you. I described how to identify and engage a mentor in Episode 4 of this podcast.
If there's no mentor readily available in your organization, it’s possible to identify mentors outside the organization. There are associations that physicians like Nina can join. They provide access to education and certification, but a big benefit is the networking and access to mentors.
Another way to find a mentor is by using LinkedIn. Membership is free, so there's really no barrier to joining. On LinkedIn search for PEOPLE with the designation of chief quality officer or medical director for quality. You can filter the list by geographic LOCATION. If there are any reasonably close by, you can start by asking to connect on LinkedIn. Later you can speak with them directly, or even meet them face to face.
Then begin a dialogue, ultimately creating a relationship in which you can ask for advice as you pursue a career in quality improvement.
4. Informal or Unpaid Experience
I suggested to Nina that while speaking with the Director for Quality Improvement, she should inquire about ongoing quality projects that she can help with, and committee meetings she can attend.
The committee structure at a hospital is fairly formal. And each committee has assigned members. Nina was concerned that she couldn’t attend a meeting if she was not the appointed committee representative.
However, I advised her that most medical staff committees can be attended by any medical staff member. Just to avoid potential confusion, it is wise to speak with the chair of the quality committee and the department chair about attending as a nonvoting member because of your interest in quality improvement. You’ll quickly become a regular member.
Doing so demonstrates commitment, offers another opportunity for networking and mentoring, and begins the process of acquiring experience in QI. By observing the chair, you will also learn about planning and running meetings, project planning and working on an interdisciplinary team, all useful leadership skills.
Nina can also volunteer to sit on any formal quality or process improvement teams that her medical group might have. Learning about process improvement is very useful. PI projects are more common in the outpatient office and procedural settings than formal QI projects.
Lean is the term used for process improvement methods originally developed and implemented by Toyota. Lean process improvement uses techniques to reduce waste and improve quality in manufacturing. It’s now been applied to the healthcare setting.
Nina and I talked about learning Lean methods in the office setting, and possibly becoming certified in Lean process improvement. Knowing Lean concepts and procedures is very useful for those interested in quality improvement.
5. Formal Education
This brings us to the next step involving formal education. You can become a green belt or black belt in Six Sigma, another PI methodology designed to reduce variation in care. As noted a minute ago, there are courses in Lean process improvement.
The associations mentioned earlier (NAHQ and ACMQ) provide formal education in quality improvement, as do other organizations:
- Institute for Healthcare Improvement
- American Association for Physician Leadership (see Episode 24)
- Many specialty societies
6. Certification and Advanced Degrees
The NAHQ provides a path to certification in quality improvement through the Healthcare Quality Certification Commission. After obtaining the necessary experience and education, you can take an exam leading to achieve the designation as a Certified Professional in Healthcare Quality. It's a national certificate in quality improvement that demonstrates expertise in the field.
You can take that a step further and complete a master's degree in quality improvement. There are multiple university programs. The AAPL has helped develop a program specifically for physician leaders. It’s called the Master’s in Healthcare Quality and Safety Management (MS-HQSM) offered by Thomas Jefferson University.
I did not discuss this option with Nina during our call. It might be best to wait on pursuing this degree until after working in a formal QI position. That might allow you to get your employer to contribute financially and with time off to pursue the degree.
7. Formal Paid Experience
At some point, you’ll want to get into a formal QI role. If you have enough meaningful experience in quality and safety projects and with the CPHQ certification, you may be able to transition to a full, or near full-time position as CQO or VP for Medical Affairs.
More likely, you’ll split your time between clinical work and quality activities as the Medical Director for Quality in a health plan, medical group or hospital. In the hospital setting, you’ll bridge the gap between clinical and management realms. You’ll be promoting quality initiatives, reviewing quality data, presenting quality reports to medical staff departments, and working with individual physicians to improve their metrics.
During this phase of your career transition, you’ll continue to hone your quality and management skills. You’ll need to focus on leadership skills also, since the Chief Quality Officer serves as a senior level executive.
Therefor, you will need to shift your educational efforts to focus on leadership topics. Organizations such as the AAPL, the American College of Healthcare Executives and the Advisory Board are just a few that offer leadership education that will help you.
Reminder: Think About Your Resume
As Nina pursues her career as a CQO, she should keep in mind that she will be competing with other highly qualified physicians. At some point she’ll be sending resumes to prospective employers.
Those employers will be looking primarily at what this new CQO can do for them. So, they’ll be looking on the resume, and soliciting during the interviews, evidence of what Nina has accomplished.
They won’t put much weight on what committees she’s been part of, or which projects she’s worked on. Instead they’ll be looking for the initiatives she’s led. They’ll be looking for evidence of metrics she’s improved. Did she get length of stay down significantly, or reduce mortality or complications? Has she increased compliance with core measures? Did she help reduce the occurrence of never events?
Keep this in mind as you participate in formal and informal positions. Don’t be a passive participant. Be a leader in these positions. Don’t just remain a committee member. Step up to committee chair when you can. And keep track of the measurable improvements that result when you and your team tackle each quality initiative.
Time to Pursue a Career in Quality Improvement
By following the steps I’ve outlined, you’ll find a CQO position.
It'll be easier if you’re willing to relocate, but if you live in a large metropolitan area, you might not need to.
The job is very rewarding, because you’ll be helping to improve the care of thousands of patients through your efforts. Quality Improvement was always one of my favorite departments when I was CMO.
Let me quickly review the steps I’ve outlined for Nina to follow as she pursues a career in quality improvement.
- Overcome mindset issues
- Demonstrate commitment
- Find and utilize mentors
- Obtain unpaid/informal experience
- Get formal education
- Acquire certifications and degrees
- Obtain formal paid experience
- Actively pursue a CQO position
Along the way she’ll find appropriate associations to join, like the NAHQ and AAPL, she’ll network with colleagues, and she’ll take advantage of educational opportunities as they arise.
I hope you found this information helpful. If you have any questions, post them in the comments section below, or contact me at email@example.com.
Don't Forget to Download Your Free Guide to 5 Nonclinical Careers
Let’s end with this quote from John Ruskin:
See you next time on Physician NonClinical Careers.
The resources included in the podcast are all linked above.