chief medical officer Archives - NonClinical Physicians

The Essential Guidebook to Being An Outstanding CMO

John Jurica — Tue, 11 Jun 2024 11:56:48 +0000

Interview with Dr. Mark Olsyzk – 356

In today's interview, outstanding CMO Dr. Mark Olszyk provides his advice and that of his co-authors from The Chief Medical Officer's Essential Guidebook.

He discusses the critical skills required for effective medical leadership and practical tips for navigating complex healthcare challenges. And he emphasizes the importance of continuous learning and collaboration among healthcare professionals to be successful.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast. The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete. By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

For Podcast Listeners

John hosts a short Weekly Q&A Session addressing any topic related to physician careers and leadership. Each discussion is now posted for you to review and apply. Sometimes all it takes is one insight to take you to the next level of your career. Check out the Weekly Q&A and join us for only $5.00 per month.
If you want access to dozens of lessons dedicated to nonclinical and unconventional clinical careers, you should join the Nonclinical Career Academy MemberClub. For a small monthly fee, you can access the Weekly Q&A Sessions AND as many lessons and courses as you wish. Click the link to check it out, and use the Coupon Code “FIRSTMONTHFIVE” to get your first month for only $5.00.
The 2024 Nonclinical Summit is over. But you can access all the fantastic lectures from our nationally recognized speakers, including Dr. Dike Drummond, Dr. Nneka Unachukwu, Dr. Gretchen Green, and Dr. Mike Woo-Ming. Go to Nonclinical Summit and enter Coupon Code “30-OFF” for a $30 discount.

The Journey to Becoming an Outstanding CMO: Insights and Experiences

John leveraged resources from the American Association for Physician Leadership (AAPL), including its Certified Physician Executive (CPE) program, to enhance his leadership skills. That is where he met Dr. Mark Olszyk, a seasoned physician leader with a rich background in military service and medical administration.

Dr. Olszyk, co-author and editor of “The Chief Medical Officer's Essential Guidebook,” shares his extensive experience in medical leadership. From his early days in the Navy to his decade-long tenure as a Chief Medical Officer (CMO), he highlights the importance of learning from successes and mistakes. The book serves as a comprehensive guide for aspiring CMOs, offering practical advice and lessons distilled from the experiences of various medical leaders.

The Role of a Chief Medical Officer: Responsibilities and Challenges

Dr. Olszyk outlines the multifaceted role of a Chief Medical Officer, emphasizing the importance of building bridges between various stakeholders in a hospital. He describes the evolution of the CMO role from the Vice President of Medical Affairs, focusing on credentialing, privileging, quality reviews, and regulatory compliance.

A CMO is a liaison between the medical staff, hospital administration, and the board of directors, ensuring effective collaboration. Dr. Olszyk also discusses his journey in medical leadership and the fulfillment he has experienced during his career.

Advice for Aspiring Medical Leaders: Steps to Take and Skills to Develop

Mark offers practical advice and steps to gain relevant experience for those considering a career in medical leadership. He encourages involvement in leadership roles within hospitals and joining professional organizations like the AAPL and the American College of Healthcare Executives (ACHE).

He also emphasizes the value of networking, seeking mentorship from current medical leaders, and continuously developing leadership skills through education and practical experience. By engaging in paid and volunteer leadership opportunities, physicians can significantly influence the future of healthcare while developing new skills, on their journeys to outstanding CMO.

Summary

In this interview, Dr. Mark Olszyk shares his extensive experience as an outstanding CMO and co-author of “The Chief Medical Officer's Essential Guidebook.” For those interested in purchasing the book, it is available on Amazon or through the American Association for Physician Leadership (AAPL) website, where volume discounts are also offered. You can reach Mark directly via LinkedIn.

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

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

Email Download New Tab

Transcription PNC Podcast Episode 356

The Essential Guidebook to Being An Outstanding CMO

- Interview with Dr. Mark Olszyk

John: During my efforts to improve my skills as a physician leader, I naturally took advantage of the AAPL, the American Association for Physician Leadership, including its CPE program. And it was during the final week of that CPE program that I met today's guest. He's a consummate physician leader, starting with way back when he was in the military. He may still be in the military, I'll ask him about that. But anyway, he's held numerous leadership and executive positions, and he's also the co-author and editor of a new book, well, it came out last year, The Chief Medical Officer's Essential Guidebook. Let's welcome Dr. Mark Olszyk to the show. Good to see you again, Mark.

Dr. Mark Olszyk: Good to see you, John. It's been too long, but thanks for having me and inviting me to your podcast. I'm really excited to be here.

John: Excellent. I have brought up the issue of physician leadership, and especially in the hospital setting, many times over the years on the podcast. And as far as I know, there are books written about the job and different aspects. But really, when I saw this book, with excellent collaboration with the AAPL and yourself with all your experience, this is just perfect for those in my audience who are thinking about moving along those lines, and actually a "how to" to get there. I really appreciate you putting this book out there.

Dr. Mark Olszyk: Oh, well, thanks. To answer your previous question, I'm not still in the military. I got out in 2003, kind of hard to believe, but I'm a proud Navy veteran, and my son is an Army ROTC. So, get that out of the way.

John: Nice.

Dr. Mark Olszyk: Yeah, yeah. The book, I think everybody at some point in their lives, reflecting on their experiences, and their travels and their journey, say, "Yeah, I should write a book about that." And I'm no different. But I've been a CMO, chief medical officer for about 10 and a half years. But I've been in medical leadership since the first year after finishing residency, I went into the US Navy. And the military, unlike almost any other sector, will put you in to leadership positions as soon as possible. And you find a way to get the skills and find the maturity and the leadership is thrust upon you and you have to rise to the occasion. I've always been grateful for that.

But I had gone to conferences at AAPL, others where I met other chief medical officers, and we would share stories. And I thought, boy, it'd be great to write this stuff down and distill this because these are some really valuable lessons, not just the things that we had done correctly, but all of the mistakes that we had made. And wouldn't it be better for other people to learn from our mistakes rather than repeat them themselves.

I guess it came to a head in our system. Physician was made chief medical officer of another hospital. And I just kind of casually passed along here's 10 things to do, like the 10 commandments, but not nearly as inspired, but just 10 things. And about six to eight months later, I guess he lost it. It was that impactful. But he lost it and said, hey, can you send it to me again? I just didn't have it. And I thought, "You know what? If I'm going to write some stuff down, let me make it into something." And it just kind of grew. And I talked to some of my colleagues and contacts. And I said, would you guys be interested in collaborating on a book? Because I think it'll be enormously boring if it's just me telling the stories. But if we have a whole chorus of voices, I think that might really strike a note.

I just had no idea how to publish a book. I just didn't want to do it on my own. I approached AAPL. And Nancy Collins was very gracious. We actually met in a Starbucks in Maryland. And she showed me some of her other publications that came out recently, one of which was a collaborative effort. And it just kind of grew from there.

I reached out to everybody I knew in my life who was a CMO or medical leader. And there was a lot of enthusiasm. I learned a lot in trying to shepherd people together for a collective effort where I was not their boss. They were not getting paid. And there was no way I could really enforce any sort of deadlines or standards. That in itself could be a book, a book about how to write a book. But it was a fun journey. I'm glad it's out there and I've received some excellent feedback.

John: Yeah, when I look through it, of course, most physicians, actually, most clinicians, of course, they like teaching, like helping their peers and so forth. And I think many, if not all, not all of the section writers or physicians, of course, you tapped into other expertise, which I like. There's a lot covered there.

And when I think about the CMO role, it's in my mind is like this iconic what does a CMO do? But everyone does it differently. Everyone does different aspects, more depending on each job. It's unique. But yet, I think you covered everything that I could think of in terms of what questions would I have if I was thinking about being a CMO or I was and I was missing something. So tell me a little bit more about the process. How did you herd all these cats and get this thing done? How long did it take you to do?

Dr. Mark Olszyk: From start to finish, it took about a year. Some of the author contributors returned their submissions in two weeks. Others took about eight months. Some needed multiple revisions, some needed none. I did recruit two co-editors, Aaron Dupree and Rex Hoffman. They helped out a lot.

I learned a lot about copy editing and all of the back office productions and placing it and formatting it. From what had existed only as a series of, I'll say, not too well organized Word documents on my desktop, to see that transform into an actual written book was pretty fascinating and eye-opening. But originally I had an idea for a structure and like all initial ideas, it went away pretty quickly.

And so I just asked people to write about what they felt that they were knowledgeable about or passionate. And the outlines of a puzzle began to come together. And then after about 75% of the submissions were in, at least an outline form, then I could actually target what was missing.

As a frustrated or wannabe classicist, I used the model of the medieval concept of the human being. The first set of chapters, the first section is about the anatomy of the CMO, the basics, the blocking and tackling, metrics and patient experience and all the quotidian day-to-day activities that were going to be the guts and the sinews and the bones.

And then we would move on to the heart, which is all about relationships and how the CMO relates to the chief nursing officer, the chief executive officer, to the board of directors, to departmental chiefs or chairs, and also their perspectives, what they think a CMO should be, or how a CMO should act to be successful in their eyes.

And then we moved on to the brain, the strategic thinking, extra hospital relationships, like how do you deal with third-party rating agencies and auditors and joint commission and dealing with the media, especially when the memories refresh from the pandemic, what if you're asked to appear on TV, on live TV, on the radio and newspaper articles how do you prepare for that?

And then finally, the soul or the spirit, which would be the transformational values and ethics and diversity, inclusion, aspirational type things. It was kind of a journey from the very basic things that a CMO would do day-to-day to the more long-range aspirational goals or values. And I think the way it's written, you can skip around. You can say, gee, I want to learn more about how to prepare for a media interview or how to relate to the board of directors. And you can go right to that section. So it doesn't have to be read in order. It can be used as a reference or it could be read as a story in itself.

John: I think it's pretty comprehensive. And probably in anyone who serves as CMO may not even be exposed to all the things that are covered. There's so much and again, because each role is slightly different. So it's awesome. One of the things I like to do when I'm bringing on an editor and author is pick their brain. So I have an ulterior motive for having you here other than just to talk about the book, although again, it's fairly comprehensive.

But just to keep what our audience's appetite here for this job because some are a little reluctant maybe they have a negative feeling about working in hospitals being abused by somebody or another, but there are good systems out there. And the other thing is being the CMO, you can make a big difference in how that organization is run. Tell me what you would say, if you were to boil it down, what are the most common areas that a chief medical officer is sort of responsible for? Maybe another way to look at it is like who reports to them, because it kind of makes me think about, okay, well, I do this because this person reports me. So however you want to answer that question in terms of the core roles of a CMO.

Dr. Mark Olszyk: I think the CMO role evolved from what was previously and still exists, usually in a hyphenated title, Vice President of Medical Affairs. That being the mechanics and the support staff for the organized medical staff. And every hospital per joint commission guidelines and through history, has had an independent organized medical staff who are largely responsible to establish their own standards for credentialing and privileging. And that was made ever more important back in the 1960s, when there were landmark cases, lawsuits, where patients began to sue hospitals. And the hospital said, hey, we have to really have some quality standards, and we're going to ask the medical staff, almost as a guild to police itself. But the medical staff have full-time jobs taking care of patients, and it's hard for them to keep the files and the minutes and the records and organize the meetings and stay abreast of all of the regulatory changes.

There is an Office of Medical Affairs in every hospital. And the Vice President of Medical Affairs, now the CMO, is largely responsible for ensuring the quality of the medical staff, making sure the medical staff leaders understand what they're supposed to do, making sure that they do it. And it's challenging in that the medical staff can be employees of the hospital or healthcare system. They can be contractors or vendors, or they can be completely independent. And when I started out at this hospital, it was about one-third of each.

To get all those different folks with their different interests aligned in a common effort proved to be a challenge, but one I thought was very fun because I had to look at their world through their eyes and also convince them that what we were doing was necessary and important and create a team not of rivals or competitors, but of people who didn't necessarily all fall into the same silo.

We're largely responsible for the credentialing, privileging, presenting those applications to the medical executive committee and to the governing body, which is usually the board of directors, making sure everyone is completing their FPPEs, their OPPEs, the ongoing professional performance assessments, making sure they're up to standards with joint commission, reviewing and knowing the bylaws. I probably know the bylaws better than anybody in the hospital. We've rewritten them 10 times since I've been here. Quality review, and then making sure that the medical staff were involved in all of the various intra-hospital, extra-hospital committees radiation safety, prescribing, that sort of thing.

What I'd like to say is that the chief medical officer is a bridge builder between the hospital administration and the medical staff, but also between the medical staff and the board of directors, between the hospital and the community. Sometimes the CMO, I found myself as the spokesperson during the pandemic especially. It was on local radio, on TV trying to break down in very understandable terms what was happening, but also bring back to the hospital and tell them, hey, this is what the community is concerned about. Here are the questions they have.

We have to be mindful of that, responsible for that. Also within the hospital, being a bridge builder between the various departments translating the needs of the hospitalist team to nursing or between medicine and surgery and sometimes refereeing, sometimes being just the host getting folks together.

But I always come back to bridge building. And again, if you look through history, through cinema, through literature, bridges always figure prominently in history, battles of the Milvian Bridge with Constantine changing the nature of the Roman Empire, Stamford Bridge, which ended the Viking Age in England. All these great events happen on bridges. Even if you've seen Saving Private Ryan, which came out, in 1998. The last ultimate scene, Tom Hanks losing his life is actually on a bridge. And if you're a fan of The Lord of the Rings, that's where Gandalf the Grey transforms into Gandalf the White. And again, Jimmy Stewart, It's a Wonderful Life. The transformational scenes occur on a bridge.

I was a scoutmaster. When the Cub Scouts become Boy Scouts, they cross over this bridge and they don't really pay much attention to it. But I gave a little speech to the parents, like, look, this is a special time, you're going from one part of your life to another. And this is punctuated by going over a bridge. Bridges represent liminal spaces, liminal time, when you're not here, or there. Bridges are a great metaphor, because they're very narrow. And they're very risky, because if you fall off one way or another, if you don't keep a straight path, if you don't keep your eyes on the goal, tragedy can ensue. And sometimes it's foggy, sometimes it's slippery. So, it takes somebody who's been back and forth a few times, who's surefooted, who is focused to to cross that bridge.

And bringing together all those communities, translating their needs and their goals and their concerns from one party to another, can be very risky. If you don't do it correctly, it can really backfire. That's why I consider the role as bridge builder. The Pope himself is the official title is Pontifex Maximus. The greatest bridge builder. I don't think the CMO is the Maximus, but I think it's a very important bridge builder, we can all build bridges. And hopefully, the CMO can exemplify that.

John: The ironic thing is that if you go back the last 20-30 years, for a while there, there weren't that many physicians in leadership positions, at least on the community hospital side you always had academic hierarchies. But I think in the 50s, up to half of hospitals might have been owned by physicians, and then over time, it just everything got split. And so I think what you just said, it's important that physicians be in those roles. So I'm glad that there are more physicians and when I started as VPMA, our hospital had never had a VPMA or a CMO. So many hospitals now do.

Building on that, tell me in your opinion, the pros and cons of being a CMO. Like I say, I have many people that are a little reluctant to make that commitment. But to me, it was a natural thing to pursue. So, what are your feelings and some of the challenges and also just what you love about it?

Dr. Mark Olszyk: Yeah, for me,this can sound a little pollyannish or saccharine, but for me, there's no downside. I guess it just fits my personality. When I was a brand new attending physician, I would see these larger forces at work in a hospital, budget, staffing challenges. And I'm like, man, I just want to be able to fix that I want to get involved in that. So it was kind of a natural course. I got my MBA so I could talk the talk and understand some of the discussions a little bit better, and then got more and more involved.

And it's just hard for me to resist trying to represent my fellow medical staff members, physicians, but pretty much trying to weigh in. If we're planning an expansion to the hospital or adding a new service line, or how do we go about on some major quality initiative, I really want to have a seat at the table and have a voice. So the best way to do that is to get into the C-suite, you get into medical leadership, develop those relationships and connections.

What I love most about the job is probably as a CMO, I'm an ambassador, plenty potentiary, I can go to any clinical department, I can go right down to pathology right now, talk to my chief pathologist. And he's got a two sided microscope, and he'll show me some slides which look like pink and purple squares. And he'll say, what is this, and I'll get it wrong every single time. Then we talk about his family. I get to know him as a person. And that builds a bond of trust, it furthers our relationship. I can walk out of there and I can go up to radiology and look at some of the images with the radiologists. And then I can walk in to the surgical suite and get gowned up and just see what the surgeons are going through, see what their day is like. Yeah, I can do the same thing for the hospitalists, for pediatrics.

I actually like being a medical student in my third and fourth years because you have a different rotation every month. It was always fresh, it was always interesting. And that's why I went into emergency medicine where you're expected to be somewhat proficient in almost anything because you don't know what's going to walk through the door. So, you have to know about pediatric medication doses, you have to know how to treat people struck by lightning or bitten by rattlesnakes or CHF in a hundred-year-old.

So, you have to know everything you have to know enough about every specialty. And then you wind up calling every specialty, sometimes in the middle of the night, but often during the course of your shift, either for follow-up or for intervention. And so, you have to learn how to speak their languages. And I just never really wanted to give that up. I didn't want to find myself just in one specialty and not continuing to learn and stay abreast of all the others.

So, I think that's the most fascinating aspect of being a CMO is, I'm pretty much given a hall pass to go wherever I want in the hospital and no one questions that. In fact, they kind of expect that. And that carries over. I get to go to the board meetings, to the finance meetings.

I can drop in on the chief nursing officer, chief quality officer. So for a person who's emergency medicine docs tend to be a little bit restless and always looking for some new stimulus, that was just a perfect job for me. So, that's my favorite aspect and one I would not ever want to give up.

John: Excellent. Now, it's interesting. We all have our own particular things that we like. I loved interacting with the board. I was on the every board meeting. I had an official presentation and I actually love spending an hour or two preparing that. I like being alone in my office and doing things to prepare for that. Whereas other people are like I want to be out there in the public. There's so many different things that one can do.

So, if there's someone in the audience who's either thinking about, well, would I like this or should I do this? Or I'm about 50% sure that I want to do this. What advice would you have for that person early in the thought process of pursuing a leadership position, let's say, rather than and it may be eventually CMO?

Dr. Mark Olszyk: Yeah, I'll approach that a little bit obliquely. So, I've given a number of leadership talks over the years and folks are always asking, well, how do I get experience being a leader? I'm like, there's no end of opportunities. Having been in the Boy Scouts, I have three sons, and they're all Eagle Scouts now. But people are always looking for leaders. And it might not be the thing you want to do forever.

But whether it's your church or civic group, the schools, they're always looking for someone to step up. And I said, boy, if you can be a Scout leader, and hold the attention of 60, 10 and 11 year olds for 90 minutes, you can do anything. First of all, brush up your leadership skills wherever you can find the opportunity doesn't have to be in the hospital.

Secondly, the hospitals are always looking for medical leaders. I've seen a ocean sea change in the last 10 years. It used to be that our medical staff meetings, our quarterly medical staff meetings, were raucous affairs, we would have 60 or 70 people there.

As our models have become more contracted or employed physicians, I guess they don't have the same feeling of being community stakeholders as when it was mostly independent physicians in the community who had been there for decades. Now the days are long. And I think after a 12 hour shift, the hospitalists want to go home. And there's also the opportunity to Zoom into a meeting. So we don't see as many people attend in person. And it's getting harder and harder to get people to volunteer to spend an hour or two, even if it's once a month, in a peer review committee, because it does take some commitment to read over the cases and then show up for the committee. And we don't stipend or remunerate anyone except for the chair or the chief.

So it's volunteer work. We're always hungry for that. I'm sure every hospital has opportunities. If you want to get involved in peer review or bylaws or credentialing, or on the pharmacy and therapeutics committee, there's definitely opportunities there. Or the foundation or fundraising, or there's lots of opportunities.

And then you begin to network. I guess the next opportunity would be just to ask your chief medical officer. You could probably shadow him or her for the day. We all like to talk about ourselves. I'm doing it right now. If someone came to my office and said, hey, I'm interested in one day being a CMO or an assistant or vice, what's the path? And it depends on the person, on their personality, what they would like to do. Everyone does it differently. Every hospital has a different set of requirements or needs. So it's dependent, but I would be very willing to talk to them. I think anybody would.

Next you could buy the book and look through that. A little selfish promotion, or you could join one of the organizations, AAPL, ACHE. States have their own chapters. Every specialty has its own chapter as well. I think there's lots and lots of opportunities. You can write articles. Journals are always looking for articles. So there's a lot of ways to just get more involved. I don't think anybody in a medical leadership position would be reluctant or hesitant just to make the time for someone who expressed an interest and wanted to learn more.

John: The other thing I found useful, I don't know if it's still the same, but talking to the CEO, hey, what's your perspective on physician leaders and what should I do if I want to get up and be part of the senior executive team? So there's tons of opportunities.

Dr. Mark Olszyk: Absolutely.

John: But we are going to run out of time. So let's talk about the book again. Let's start with what do you think is the best way to get the book? Should we go to the AAPL? Should we go to Amazon? Are there other ways of finding the book?

Dr. Mark Olszyk: Either one of those is fantastic. If you go through AAPL and you want to order a lot, there are volume discounts or you can go to Amazon, it's easy. You can type in chief medical officer or even my last name, which is not too common, Olszyk book, and it'll pop up. You'll see a couple of Amazon reviews. Unfortunately, some were written by my children. Ignore those. And if your listeners or podcast watchers do get a copy, please do leave a review. It's important. But yeah, either way, you go through AAPL. I think there are some other platforms out there, but those are probably the two most common and easiest to go through.

John: That makes sense. What if they have a question for you? Can they reach out to you?

Dr. Mark Olszyk: They can reach out to me. Yeah, I'm on LinkedIn, as you know so you can direct message me. People have done that and I've responded quickly.

John: Okay, good. Excellent. It's good sometimes just really to talk to the editor or author. Of course, you wrote several of the sections of the book in addition to being the chief editor and you said you had some help with that. But okay, well, any last bit of advice before I do let you go in terms of the future of medicine and physician leadership therein? Any other words of wisdom before I release you from this torture?

Dr. Mark Olszyk: No, it wasn't torture at all. I really enjoyed it. It's good seeing you again. And again, thank you for the opportunity. Clearly, like everything else, medicine is going to change more in the next 10 years than it has in the last two generations. So if you want to be part of that change, get into a leadership position, let your voice be heard. I think a pessimist is someone who takes no joy in being proven right. And an optimist is someone who thinks the future is yet uncertain. So if you want to help craft the future, get involved.

John: That's awesome advice again. And I think physicians do resonate with that for the most part. I want to thank you again for being my guest. I might have to have you come back and dig into one of these topics that's in the book, maybe in more detail at some point, but it's been great talking to you again. We appreciate you sharing your expertise with us today.

Dr. Mark Olszyk: Cool. Thanks, John.

John: You're welcome.

Scroll back to top

Sign up to receive email reminders, news, and free stuff every week!

Enter your name and email address below and I'll send you reminders each podcast episode, notices about nonclinical jobs, information about free and paid courses, and other curated information just for you.

powered by

Disclaimers:

Many of the links that I refer you to are affiliate links. That means I receive a payment from the seller if you purchase the affiliate item using my link. Doing so does not affect the price you are charged. I only promote high-quality products and services that I believe will be useful to you. As an Amazon Associate, I earn from qualifying purchases.

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career.

The post The Essential Guidebook to Being An Outstanding CMO appeared first on NonClinical Physicians.

Add the SWOT Analysis to Your Growing Skill Stack

John Jurica — Tue, 23 Jan 2024 13:27:38 +0000

An Important Business and Management Tool

In today's episode, John describes why the SWOT Analysis is an important tool for physician leaders and how to use it for project and strategic planning.

The process of shifting to a nonclinical career often involves learning and applying new business knowledge and skills. Most physicians have not been exposed to formal project management or strategic planning concepts during their medical education. The SWOT Analysis is a well-known business tool that is easy to learn and implement.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.

By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.

Did you know that you can sponsor the Physician Nonclinical Careers Podcast? As a sponsor, you will reach thousands of physicians with each episode to sell your products and services or to build your following. For a modest fee, your message will be heard on the podcast and will continue to reach new listeners for years after it is released. The message will also appear on the website with over 8,000 monthly visits and in our email newsletter and social media posts. To learn more, contact us at john.jurica.md@gmail.com and include SPONSOR in the Subject Line.

Our Episode Sponsor

Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Building a Stronger Skill Set for Career Advancement

This week, John emphasizes the importance of acquiring new skills to enhance one's professional profile. The focus is on business skills crucial for executive and management positions. John suggests that expanding one's skill set in negotiating, contracting, health law, management principles, HR principles, and leadership can significantly enhance attractiveness to employers in the healthcare sector.

Mastering the SWOT Analysis in 15 Minutes

By sharing personal experiences and using a hypothetical healthcare scenario, John illustrates how SWOT analysis can be effectively applied to make informed decisions. Below is an example discussed during the presentation.

Decision Whether to Expand Healthcare Services

Scenario: John recounted a situation where his team needed to decide whether to expand healthcare services (urgent care) into a new area.
– Strengths: The organization was the largest and most successful hospital in the community, with a significant financial advantage, brand recognition, and a successful history of physician recruitment.
– Weaknesses: Lack of experience in urgent care, ongoing strategic initiatives such as starting an open heart program, recruiting a new radiology group, and completing a new wing addition to the hospital.
– Opportunities: Rental space availability, community demand for more physicians, and a supportive medical group interested in expanding primary care services.
– Threats: Large uninsured population, potential external competitors, and concerns about the reaction of the existing medical staff.

By considering the above factors that were discovered during a SWOT Analysis, our team was better able to make an informed decision about the risks and benefits of proceeding with the planned expansion. Based on this analysis, our health system decided to move forward with this initiative.

Using a SWOT Analysis in Other Situations

Doing a SWOT analysis is also very useful in the context of regular strategic planning meetings. When dealing with various strategic initiatives a SWOT analysis of each can be part of the decision-making process for allocating resources to specific projects. A SWOT Analysis will help identify priorities, assess the potential impact of each one, and help decide how to allocate resources effectively.

Summary

John illustrates how SWOT analysis can be effectively applied to make informed decisions in the healthcare sector. It is a simple process that any healthcare leader can learn to do. And it makes a great addition to your portfolio of management and leadership skills needed to land your first executive position.

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

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

Email Download New Tab

Transcription PNC Podcast Episode 336

Add the SWOT Analysis to Your Growing Skill Stack

John: It's a good idea if you're thinking about moving into some other area that you might consider obtaining new skills that you can stack on your existing skills, and that makes you more attractive to certain types of jobs. And a lot of those skills and a lot of that knowledge is basically business skills and information. In fact, I was thinking about this earlier and much of what I'm going to talk about today, the types of skills that you might want to accrue, we talked about last time. You're pretty much going to find those if you happen to be a member of the American Association for Physician Leadership, including a leader in an executive position. So, you're going to need to know all of those business skills like negotiating and contracting, health law, and management principles, HR principles, leadership principles, and so on and so forth.

Today, I want to give you a little mini MBA course in 15 minutes. This is a session in which we are going to talk about SWOT analysis. What is a SWOT analysis? Now, I remember probably sitting in a room one day, I think it was shortly after I became VP for medical affairs. I was in the C-suite, and I was listening to these conversations. I was acclimating to this new job, and I heard somebody talk about, "Well, we've got to do our budgeting at the end of the year here, and we're going to be setting some management goals and so we need to do a SWOT analysis. Then we can be prepared to move forward on that." I'm thinking "SWOT analysis, that sounds pretty... Is that like a SWAT team or something?" But for those that know what it is, you're kind of chuckling because the SWOT analysis sounds like some really great tool, but it's been around forever.

The SWOT just simply comes from the acronym of what you're doing when you're doing a SWOT analysis. And that is for whatever problem you're looking at, you're trying to solve and maybe develop a set of goals or make a decision about, you're just going to look at these factors which have been shown to be important in decision making about whether to proceed with something like this or not, or choose from among a multitude of options. We got 10 different things we want to do. How do we figure out which of those 10 are the highest priorities? Well, you could do a SWOT analysis. There's lots of ways that a SWOT analysis is used.

Now, I will mention this. You may want to read about this, and actually, even Wikipedia does a pretty good job describing this, but you can look it up on Google. You can find almost any kind of business management book will have it. I'm sure it's taught in schools that provide MBAs and MMS and MHAs and things like that.

But the SWAT simply refers to the S is Strength. The W is Weaknesses. The O is Opportunities, and the T is Threats. And so, you take whatever it is that you're dealing with and you bring it through that process. I'll tell you when we use this frequently. I would use it with my managers, and sometimes the senior team would use it to develop a maybe an hour or two session at our strategic planning meetings.

Now we had biweekly or weekly strategic planning meetings. Then we would do a SWOT analysis every time at that, although we could do it at a particular meeting. But if we did an annual, you would call more of a management goal meeting, because the old days we did strategic initiatives that would be looking out three to five years. And there's still sometimes where that's important to do, but generally we're doing year by year.

And that's that short term strategic analysis and plan became really the management plan, which meant that every V line goals that the superior had decided we were going to do for that year coming up. We usually did this towards the end of the year, although not quite at the end because we wanted to know what these initiatives would be before we actually set the budget, as opposed to saying, "Well, I think we're going to extend our hours on weekends." You could do that without necessarily a huge budgetary impact. And in that case, the revenues would offset the expenses anyway. But still, even there, you might want to do that.

I've written about in the past an example of what this might look like. So, I'll just give you an example and we'll walk through it. Let's say that we were in a group, either a private group or part of a hospital medical group, and we decided that we were going to do a SWOT analysis to decide whether we should proceed with an expansion into a new primary care or urgent care service in a new area that we hadn't been in before. We're like, "Okay, we're in a hospital, we have a competitor hospital basically within walking distance. There are some other competitors out further, but basically we have that to contend with." And then we have to consider all the factors that might go into whether we can and should do this. Do we have the budget for it? Are we growing? Do we want to grow? Do we have staff for it? And so forth.

So, let's see what the SWOT analysis might look like. And this is just a partial SWOT analysis, but we're looking at this. And so, let's talk about in a brainstorm about our strengths. At the time, we were definitely the biggest hospital of the two and the most successful I would say in the community. We had a much bigger bottom line. We had $300 or $400 million net revenues, and the other one maybe had a third of that. We had employed a base of physicians. We were fairly successful at recruiting physicians. We had a very healthy bottom line for the last five years. We were making money unlike other hospitals in the state of Illinois who many were losing money.

And what are the other strengths? We had a great brand recognition. We had gone through some marketing consultations in previous years. We had some pretty tight branding and marketing. We had good logos and they had been consistent color palette and that sort of thing. Like I said, the finances were strong.

And then the other thing is, do we have physicians interested in this? And we did have those inside the medical group, the primary care doctors already interested in finding new locations to do this. And if we looked at who was in our team right now, the team that was running the group had a lot of depth. And so, we could take on, we felt in that situation, pretty readily expanding into a new territory. Now, we would also have to decide things like "Are we going to build or are we going to lease some space? How much do we want to commit to this from a budgetary standpoint? Is it going to be enough?" But so far so good.

Now, weaknesses. At the time we were looking at adding an urgent care clinic. Basically we had no experience in urgent care. We were not doing any urgent care. There were some urgent cares in the periphery of our service area. They were all either independent, freestanding, individual urgent cares or large regional groups that we're expanding. And it's a little different competing, let's say, with an urgent care that's run by an entrepreneur as opposed to an urgent care run by a hospital, which typically loses money, but they make it up on the referrals and that kind of thing. No expertise in that.

We had already several pretty pressing strategic initiatives. I don't remember exactly, but let's say that we were do starting an open heart program and we were in the process of recruiting new radiology group and we were still finishing up the addition of a new wing to the hospital. Those are weaknesses because there's a lack of depth in terms of the ability to manage something at maybe a higher level management directors and VPs because we had these other big projects going on because we didn't have the experience.

And the other thing is we were really having trouble at that time recruiting staff fast enough to maintain and keep up with our growth. The area we were looking to go and didn't have urgent care. In fact, the general area around us didn't have urgent care. We were looking at ways to prepare for value-based contracting or prepaid plans, keeping costs down basically which means keeping people out of the emergency room, which is basically what primary care and urgent care does if you have enough capacity. Shunt those people. That's one opportunity we had never pursued before.

It just so happened there was rental space available at several locations in the town in which we were looking to put the urgent care. And we had heard that the community definitely wanted more physicians. We probably should have done a little more digging on that, whether what type of physicians, but basically they just wanted physicians because there was a lack of. This place is a good 30 minute drive outside of the main area where our hospital was located, and it was pretty rural, but still had some population density there.

Now the threats. That's T. The threats for the SWOT analysis could be things like, again, you just look all those areas, finance, growth, marketing, branding, reputation, quality, staffing and HR issues. All those things. And now you look at the threats. Mostly we're looking at threats that are coming from outside, but one threat is that there was a very large uninsured population. Sometimes that could be tricky in terms of how to set it up and how to make sure that you could serve the needs but not lose a lot of money in the process.

The second threat was that we had heard there were both competitors external to our market looking to expand potentially. And then also at the other hospital and in a group of primary care physicians thinking of doing it themselves. They were probably going to start it on their own, in their own offices and expand maybe into this other thing. We need to be aware about that.

And the other threat that we came up with at that time was the fact that our medical staff might not like this idea of us recruiting more and more physicians because a lot of the medical staff at that time were still private medical staff. They were not employed. And so, they would feel threatened by us and they could do things that would make it difficult. They could say, "Okay, we're taking all our business dealer hospital because they're not hiring physicians as much as you are to compete with us. So, those are the kind of examples of some of the strengths, weaknesses, opportunities, and threats.

Now you do that for five or six or seven different projects that you're thinking about. And then by balancing those out and really get into the financial piece, you'll need a pro forma or at least a thumbnail sketch of what the cost of the different projects are, and then what's the return on a clinic or something that might take two or three or four years to really break even. If you add a new service line and get to be successful in three or four months, then you're going to get the return on investment more quickly.

What we would do from taking that SWOT analysis, we would take that to the next step of goal setting so that this is how we would translate it. We would use language like this. For my department, how can we utilize our strengths and acts to take advantage of the opportunity? That's the strengths, the S. How can we utilize our strengths in this A, to minimize the threat coming from B, or how can we take advantage of the opportunity to Z minimize our weaknesses in V.

Let me just give you some examples. This is how we would phrase things if we're going to put some of these together. Following what I just mentioned, I'd say for my department, this would be a manager talking. I had usually between four and eight departments reporting to me. But for my department, how can we utilize our financial strength and strong interest by the medical group to staff an urgent care clinic? Again, how can we utilize our strong management team? That was one of our strengths, to minimize the threat of the large percentage of uninsured in the market. Somehow take care of the uninsured, we've got a good team, we need to leverage them.

Another example, how can we take advantage of community support to minimize our weakness, which is difficulty in recruiting support staff. How do we get the community to help support us getting staff in? And there are big ways to do that. That's where I'm going to end it. But this is something that like I said, you can learn about pretty much anywhere, any business book. You can actually do some business courses at the AAPL that we'll talk about this.

But for a quick review and definition of all the terms, then I would just say go to Wikipedia and look up SWOT analysis. And whatever job you're in and you're being asked to participate in a planning session or to provide feedback. Because I've done this, I am on the board of a hospice and we were doing a strategic plan one year and I said, "Hey, if you want me to take the team through a SWOT analysis, we'll go through the whole thing, all these different areas for where the hospice is in terms of strengths, weaknesses, opportunities, and threats." And we used it for the management team to develop their goals for the following year. And since I had done several SWOT analysis and I thought, "Well, let's have him lead this one and then we can get someone next time to lead it for the rest of the team."

All right, that's all for today. Thank you for listening and I will see you next week. Thank you for listening and watching.

Scroll back to top

Sign up to receive email reminders, news, and free stuff every week!

Enter your name and email address below and I'll send you reminders each podcast episode, notices about nonclinical jobs, information about free and paid courses, and other curated information just for you.

powered by

Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. I only promote products and services that I believe are of high quality and will be useful to you. As an Amazon Associate, I earn from qualifying purchases.

The post Add the SWOT Analysis to Your Growing Skill Stack appeared first on NonClinical Physicians.

What Makes a Great Health System Chief Medical Officer?

John Jurica — Wed, 17 Jan 2024 16:05:09 +0000

Interview with Dr. Nilesh Dave – Episode 335

Today's podcast episode describes Dr. Nilesh Dave's four-year career transition to health system Chief Medical Officer. We pick up from his previous appearance 4 years ago in Episode 99, as he lists the steps he took on his interesting career journey.

Starting with his role as medical director at a regional Blue Cross Blue Shield subsidiary, he describes the steps he took to land his position as VP for Clinical Effectiveness and CMO for a large hospital system.

Our Show Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.

Our Episode Sponsor

If fear is part of your struggle, too, she would like to help you push through those emotional barriers to go after the life you really want. Click this link to schedule a free chat.

Or check out her website at allthingswriting.com/resilience-coaching.

Career Transitions and Leadership Growth

Dr. Nilesh Dave's evolution from medical director to CMO for a health system highlights the importance of diverse skill sets in nonclinical leadership roles:

Adaptability across domains
Cross-pollination for innovation
Strategic thinking
Learning and adapting to new technologies

Nilesh emphasized that a combination of clinical knowledge, business acumen, and the ability to adapt to new technologies is essential for success in these roles. Some of these skills developed as he pursued additional formal education, including an MBA and executive training in Artificial Intelligence in Health Care at M.I.T.

Navigating Challenges as Health System Chief Medical Officer

Dr. Dave's role as a CMO involved navigating the challenges of a complex healthcare system. It requires a combination of strategic leadership, analytical thinking, effective communication, and collaboration to drive improvements in clinical outcomes and overall system efficiency. He began developing many of these skills in his previous management roles.

Summary

If you're interested in connecting with Dr. Nilesh Dave and exploring more about his insights into nonclinical roles in the healthcare industry, you can reach out to him on LinkedIn. Dr. Dave often shares valuable perspectives on clinical effectiveness and leadership, making his LinkedIn profile a great platform for networking and staying updated on the latest developments in the field. You can find him on LinkedIn by searching for Nilesh B. Dave MD.

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

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

Email Download New Tab

Transcription PNC Podcast Episode 335

What Makes a Great Health System Chief Medical Officer?

- Interview with Dr. Nilesh Dave

John: I can't believe it's been four years since I last interviewed today's guest. I wanted to have him come back because his nonclinical career has flourished since he was here before. And he's in a leadership position now of a large hospital system, which is awesome. I think he has a lot to share with you all today. With that, let me welcome back Dr. Nilesh Dave. Hello.

Dr. Nilesh Dave: Hi, John. It's great to be back. I'm looking forward to chatting with you over what's been going on over the last four years and hoping that any of your listeners out there will hopefully get some nuggets of information and hopefully that'll help them get to the similar or whatever pathway they're on.

John: I think it's going to help a lot, and I have a lot of questions. But when we last spoke in July of 2019, I think it's okay I can mention you were basically working for one of the regional Blue Cross Blue Shield companies but you're no longer there, obviously. That's why I wanted to have you come back. You've made a couple of different changes and you've also done some other things in between. Why don't you tell us what happened, why you decided to move on and what the next job that you did was that would utilize all of your skills and education?

Dr. Nilesh Dave: Yeah, sure. I'm happy to. When I was working for one of the subsidiaries of Blue Cross Blue Shield, I was outreached by another insurer to join their team. And the resources there that they had in analytics and the opportunity to get involved with more business innovation in that space, as well as population health, was too hard to pass up. And so, I literally had to just drive down the street for that when I took that position and learned a ton. I was never someone who actually liked the utilization management component, and this was a minimal part of the entire role.

A lot of jobs in the nonclinical world will sort of describe themselves as working across a matrix or working across silos, so to speak. And I have to say that doing that transition to the other insurer ended up really teaching me some of those skills that it's not anybody that is above or below you in sort of a hierarchy. It's another department and group, but you've got a common client or something like that. And that's what brings you together in achieving some of the business objectives.

And when I was there COVID was starting up. And so, I was enjoying that role. And then I thought, you know what? I want to maintain my clinical skills. And so, I signed up to do some tele ICU moonlighting shifts. With being in a corporate position and having regular hours, it was not difficult to find time to do a clinical shift.

I started doing that and it was different. It kind of checked off the box of, yeah, it's critical care, and I'm an intensivist by training, but it was in a different way. It was tele ICU. I wanted to learn more about that because things were shifting towards telehealth and certainly COVID accelerated that and made telehealth a more accepted way to also deliver healthcare. And so, I just expanded my skill and exposure to it and signed it up.

And then I guess serendipity is what happened next, because I ended up being asked to oversee that multi-state tele ICU operation. And I almost did a double take when I was asked that because this was an opportunity that aligned my clinical skills. I had gotten a business degree before. I was in charge of quality, metrics and policies for the health system that this was a part of. And so, that had some inroads to my master's in public health I did in between medical school years. It just seemed like this makes complete sense. Like why not do something like this that you can get at all these skill sets in under one roof?

John: That's impressive in a way. But also what was the old saying? What is good luck? It's the combination of preparedness and opportunity. Unless you're open to it and you're prepared, however that preparation occurred, you just never know when you take a new position or volunteer somewhere or whatever, what opportunities might show up. What were you doing there? Just to clarify, I was going to ask you about the location, but it sounds like you did not have to move to take on this new role. You said it was down the street.

Dr. Nilesh Dave: No, in fact the company's headquarters moved from Boston to Dallas. And so, their operations for their tele ICU was also located literally within a block of the other two jobs I had previously. It was just sort of a business park, I guess, and that's why. I didn't have to drive really anywhere else.

John: Another serendipitous thing in the sense that there's a lot of movement out of many states, but Texas is one where there's a lot of movement in. And that includes corporations as well as people.

Dr. Nilesh Dave: That's for sure. Yes.

John: You loop selected a good place to live and grow in your career. That's another thing to keep in mind. Tell us again, at the beginning, before you were doing the moonlighting, before you were heading down this telemedicine service, what were the actual duties that you were doing that were different from what you had been doing earlier in your career?

Dr. Nilesh Dave: At both insurance positions, there was a new program that both insurers had started in terms of a white glove population health management service for employers, employees or members of the insurance. And looking at cost of care, drivers of care, managing and understanding the population of workers and really using your medical knowledge and understanding like, okay you've got diabetes, which is a risk factor for coronary disease, and the folks that work in the different divisions of this company. The company had 400,000 people in the Blue Cross Blue Shield subsidiary that I was overseeing. And so, that was a lot of that population health more so. But when I moved to the other insurer, there was more sort of KPIs, key performance indicator, and data associated with that that we focused on as we were managing.

I was managing three different companies with very disparate populations and risk factors. And so, I had one that employees would be in remote locations building solar farms, wind farms and stadiums, and another that was building nuclear subs and the third in drug development. And these are all employees with different kinds of health problems and some very similar.

But in that second role, there was a lot more of a business focus, a lot more strategy, data-driven analytics, and the opportunity to use that data capability that the company had to think of innovative approaches to some of those problems. And so, when I pivoted away from the Blue Cross Blue Shield position, that's what I got out of that second job.

And that retrospect, I think that set me up pretty well for when I started doing the tele ICU operations across multiple states. We had the same kind of set up. We had a lot of analytics. We were in charge of quality and metrics. We had key performance indicators that we had to meet. The usual ventilator length of stay, ICU length of stay, mortality. That's in the medical clinical world, that's when you're in these sort of hybrid clinical business positions, a lot of those things are what you're looking at. And so, being able to be in that tele ICU position really solidified that. And I was able to leverage then my clinical knowledge as well, knowing what does it take to take care of an ICU patient and translate that into the business side for health system.

John: That's what I think is great about physicians that move into these more executive positions, is that they do have that understanding of the relationship with the patient, the needs of patients, medical terms and all that. And if you can just add the business side of it, to me, it's an ideal situation. I think the companies you've worked for, they've recognized that. They have CMOs and they have physicians in pretty high leadership positions unlike a lot of hospitals. Some large hospitals do, but there are a lot of hospitals out there that the first thing they did when the pandemic hit was get rid of their CMO because it was an expensive position, at least from what I've heard. That's why I think physicians sometimes get frustrated working in a health system, but I think you still have to fight for that. And if your colleagues that are at the hospital recognize that they can hopefully encourage the leadership of the hospital to get more physician leaders like yourself. Tell us the next steps. Anything else you want us to tell us about that position you were just describing? I know after two or three years then you found something new to pursue?

Dr. Nilesh Dave: Yeah. There were a few variables that sort of were in the mix, that the health system where I was doing the tele ICU had some struggles and things that were financially related. And so, the tele ICU program was being contracted and expansion was being halted. And being able to grow in that position, it was pretty clear it was going to be delayed for several years. And a lot of the planning and things that we had at the beginning of when I took it a few years later, that was all sort of cut. And so, at that point, an opportunity at a Dallas based health system, the largest one by footprint, in terms of hospitals and things, was advertising a clinical effectiveness chief medical officer position.

And so, I threw my hat in the ring. And obviously after rounds of interviews and things, they offered me the position. One of the things, my background is a divergent one. When you look at, I'm at a system level. We have a system CMO. In some ways you could say I'm an associate system CMO, but they carved out a different CMO role with different parameters. And my background does not fit the "Hey, I've been in a hospital CMO for years and now transitioning to a system level." I was at a system level with the tele ICU, and in some ways I was the critical care subject matter expert overseeing our tele ICU operations and quality and meeting all those metrics. In some ways, there was some similarity to that CMO role, but I did not follow a traditional pathway. And in fact, I think I was very fortunate to be in a company now that actually appreciated my payer experience and my telehealth experience, which they've never had that background. And they thought that that would be an advantage for them based on the personnel and skillsets that they had which was a nice refreshing thing to hear.

John: When you were looking at the job title, if they posted it as such clinically effective CMO, they could have said chief clinically effective as medical officer or something else, but I've heard the term clinically effectiveness, but I've never heard that applied to a CMO. What were you thinking when you first looked at that?

Dr. Nilesh Dave: I figured that there were probably service lines or clinical service lines that between hospitals, they were probably performing at different levels. And I'm sure I expected that there would probably be similar sized hospitals with similar availability of specialties, but their quality metrics, we're not predictably the same. And so, I was sort of trying to figure out what's driving that? And it turned out that thinking before learning more about the position, the position was a new one that they had. It wasn't one that they had established years ago. They got rid of one position and sort of reformatted it. And so, for them it was also a new thing. And it was not only clinical effectiveness from the way you would think in the service line area, but also risk management, safety, credentialing, medical staff affairs.

I'm also involved in deploying our telehealth strategy. I'm on their AI governance task force, the tele ICU. And I've always been into the tech stuff. And so, now with AI, generative AI and things really versioning and so many platforms and vendors out there trying to get a piece of the pie, we had to create a governance structure, and I helped create a framework and took some time to take a certification course from MIT on AI and healthcare as a way to just compliment that because I knew some, but I didn't think I knew enough. And I just did that on my own while in the role taking classes and things online and learning that stuff. Once I saw some of these other aspects of clinical effectiveness, and it really is just making the clinical engine run, as smoothly as it can, that's what it kind of boils down to now. And it's been a phenomenal experience.

John: Describe some of the things that you do in that role, that are more leadership management and so forth. I think it's difficult sometimes for physicians to understand what it's like to move from that strictly clinically, even if you're the head of a service line or something, to working at the level of let's say a senior VP chief medical officer. But it's going to be different for every system as well. You move from one to another. What does it look like for your system? Who are your peers? Which other senior leaders do you regularly meet with or report to for that matter? That would be interesting to hear how that's structured.

Dr. Nilesh Dave: Yeah. Interesting. I'll add one other point is that when I was in the tele ICU position, I had 40, 50 nurses, and probably the equivalent number of physicians on our internal tele ICU operations. I had a whole team, had administrative folks helping to run the operations, a nursing counterpart, and a few other internal business partners. When I joined my current role, the directive was to get things done working through the business. Other than an administrative assistant who's fantastic, I do not have a hundred person team under me or any of that. That's one big difference that I have already in the job, which was a bit strange to me, based on the projects and things.

But I came to learn through listening to interviews like this, that there are many folks who are in these sort of officer positions that work through the business and get things done. And so, on a day-to-day basis, the folks that I interact with could be other VPs who oversee our hospital channel, for example. We have all our hospitals in a channel. We have an ambulatory channel and telehealth channel. And so, we have VPs that oversee that and a lot of them are nonclinical, business trained background. And so, I work a lot with them on different aspects of my projects. I even will directly collaborate with the COO of the company, and occasionally with the CEO and CFO as well as the strategy officer.

It's not a completely sort of flat organization in that sense, but the opportunities are there, and at times necessary. And I also work with the chief medical officers of each hospital. They don't all report to me. They're sort of a dotted line to myself and my colleague. And so, we collaborate together with them. We work with the chief nursing officers, hospital presidents are sort of in the business channel, but we work with those executives at the local hospital levels and then their sort of system counterparts who are maybe senior VPs or executive VPs or whatever. It's all across the board. I work closely with the VP of care transition management who oversees all of the folks in the hospitals. And so, it really is a pokery of various officers. At all levels, it's not just officers.

John: Yeah. When I was working as a CMO, of course, it was a small, it was a hospital, so it was very contained. But we just say that was a matrix relationship. We knew that if we had something we had to get done, it wasn't that I had to go through another VP. I would just deal with whoever I had to deal with to get it done. And then hopefully we're all on the same page, had sort of the same strategic plan and management plan that we were working on. And so, at that level, you even have to learn how to give up a little bit of something. You have to make someone else's thing work, because it's for the overall improvement of the organization, not your own little fiefdom within it. That sounds really goods.

The other thing that it makes me think about is when going through some of the courses at the AAPL and what I've taught when I've heard from others doing MBAs and so forth, the importance of things like negotiation, communication, persuasion even as a thing. And it's all about doing that rather than there's no such thing really anymore for the most part of just saying, "Okay, I'm the boss, so I'm going to tell you what you're going to do."

Dr. Nilesh Dave: I think that's a great point because one of the things you had mentioned is that a lot of times folks with these opportunities sometimes struggle, and in reflection, I think there's a struggle. Part of the struggle comes from just the language. A lot of us who may be doing day-to-day clinical practice and maybe are involved in some greater hospital initiatives or maybe it's the health systems doing your cardiologist and there's some cardiovascular service line initiative, and you're doing some of that, but being able to translate that into business speak.

And in fact, when I had to do my resume as I was pivoting into the nonclinical world, I think on our last discussion, I had mentioned that it took me a while to understand how to convert "Hey, I set up a system-wide inpatient hospice program." Well, there is another way of saying that on a resume that resonates with the nonclinical business executives that you might end up working with.

And to your point about getting allies and strategizing, it's a lot easier when you have that one patient in that one room and you're talking with different consultants. For one consultant or for a combo, your hand is forced because of the clinical scenario situation and the direction it is going in. And so, you have no choice but to agree and just take care of it. On this side, you know that is going on, but you're doing things system-wide that aren't directly related to that patient and related to operations or strategy, and a lot of that maneuvering, change management negotiating, let me do a solid favor for them now and hopefully that'll be repaid when I'm in dire need of something as well. And I'm not keeping a little notebook of what I've done, but the people you work with, you kind of know, they'll remember and sometimes you have to bring it up. That's a different skillset. I had to learn a lot of it. I wasn't like one of those schmoozers who could easily just do that kind of thing naturally. That's not always the kind of people who can get things done in these roles. There are skills to learn.

John: Yeah. Yeah. If you have a culture where that's the way things are done, it helps, but there's always individual personalities and some people are more forthcoming. I remember I had a director that reported to me, and I loved her dearly, but she may be crazy because if somebody didn't do something they promised like within a week, she'd be like, "It's not my problem. But they said they were going to do it." It's like, no, you have to take responsibility beyond yourself and enable those other people to do what they are supposed to do without being so black and white. That's just another example.

I'm glad you're here because I did have one or two other things I wanted to ask your opinion on, because you have some experience with these things. For example, you did that MPH back while you were in med school or between years or whatever, you did get an MBA and at Kellogg too, I think it was. It's not a community college MBA. And you've done other things. I don't know if you've ever been a member of the AAPL. I'm just wondering your opinion on all of those things, whether there's a prioritization, if someone hasn't done any of them, or what your advice is on deciding on an MBA, deciding on doing an MPH or doing some other things. Like you said that you got some additional training in telemedicine and AI and that kind of thing.

Dr. Nilesh Dave: Yeah. Funny enough, when I was in med school, my desire was to be in infectious diseases. And at the time, I wanted to learn more about epidemiology, biostats and health outcomes. At the time that was the buzzword. And when I did mine at Johns Hopkins, they had a program for with all that, and it was just a one year program. I didn't go into infectious disease but I did learn some skills, especially with the epidemiology and the biostats that from a data analytics perspective, which I would not have predicted back then, ended up helping me out. I pursued that because in the moment it made sense for what I was trying to do.

The business degree, I've been asked and I also hear the question of, "Well, I wanted to do something nonclinical so I better go ahead and get my MBA because that's like a lot of our physician pathway, we've got to get a medical degree, or a doctor of osteopathic medicine degree or something and be able to be that doctor." But here, an MBA is not mandatory. There is the American College of Physician or I forget, Healthcare Executives or something. The ACHE or something.

John: Yes. That's the one that's more for the hospital. ACHE.

Dr. Nilesh Dave: Yeah. There's an MBA like program you can go through there. I did it because I knew I lacked the ability, and when I was doing system-wide stuff as a practicing intensivist, getting involved in some of the health system initiatives, I was having a hard time trying to communicate effectively with nonclinical business leaders. And if anything, I felt like I was just oversimplifying things and as I listened closely in meetings, I saw that there was a gap. And so, I did that.

But at the time, I was not doing it hoping that it's going to open a thousand doors of opportunities. That did not open really any doors right away. Even with an alumni network that was strong in all of that. That was not something that was automatic. You still have to hustle and try to find those opportunities and hope that one thing builds on another and sort of strategize like that. And those skills ultimately will come in handy and they have for me now.

But it's a false way of thinking if getting an additional degree is the gateway to doing things like this. There are plenty of folks that I know that don't have a public health degree or an MBA or Master's in Health Administration, or any of those, that are fantastic leaders. And whether they've done work on the side to learn that stuff, it's possible, I don't know. But it's not necessary.

John: What I'm hearing, it was like the MPH, there was a reason at the time that you did that, and then with the MBA, you were already understanding, I don't know, maybe budgets, maybe financial statements. You had the people you were talking to at that time and you thought, "Okay, this is going to help me to address that need."

Dr. Nilesh Dave: Yes. And I was also at the time thinking a little bit entrepreneurial that maybe I'll sort of do something different on my own. I wanted some of that background and I thought about should I go and pursue a healthcare related MBA or not? And I actually decided conscientiously to not do a healthcare one. I wanted to meet people from all kinds of industries because my background is divergent, my thinking is divergent. I like to cross-pollinate with folks in other industries to have a better innovation mindset. And so, I looked at it that way and chose a program.

John: Yeah. That makes sense. Because I do hear the same thing. "I don't know what I want to do. I want to get out of medicine, so I'm going to get an MBA." And it's like, well, that's a little bit of a shotgun approach in the sense that it doesn't really give you any particular direction. And I think employers too, they're going to be working for someone like a big system or insurance company or pharma. They're going to look at that and say, "Well, it doesn't really fit in any kind of logical step in your career." You just decide one day to get an MBA while you're practicing full-time in family medicine or something. I'm sure those things long-term can benefit in unknown ways as well, but it's a lot of time and money to invest without having necessarily a direction that you're shooting for.

Dr. Nilesh Dave: I wanted to add, especially for the benefit of the listeners, that when I took on this role, and even when I was in my previous role, I had started to work with an executive coach. And at first I was like, "Well, I don't know. Do I really need that? We're all smart and savvy enough. Maybe we can figure this out." But no, emotional intelligence is probably the number one most valuable skill and capability that you need to grow and mature when you're in these types of positions.

And there's frameworks of how to manage workloads and how to have those conversations and negotiating the talking with different folks and trying to not only get the stuff on your table moved forward, but a collaborative project as well. There's skills there, not necessarily soft skills, but there are some hard skills as well that for me, it was something that I thought would play into the brand that I wanted for myself. What I want to be known for and how do I want to execute on that.

An executive coach was something that continues to make sense. I've been working with the same person now on a second year, monthly, before it was more frequently, especially when I was onboarding in this new role at the end of April. I throw that out there just because not everything is in the books. You do need it. You do need sometimes some coaching. Will there be a time where I won't need it? I'm not sure. It just depends.

John: Yeah. Unless you've had a coach like that, you really can't imagine the amount of wisdom that you can get from a coach. And they're kind of like a therapist in a way. They don't just tell you what to do. They get you to generate the "aha" moments and just help you to clarify your thinking. The bottom line is it doesn't make you a better person. Everything you would've maybe eventually learned, I think just happens faster when you're in that situation.

Dr. Nilesh Dave: I agree. And sometimes in the chaos, they can help tell you "Yeah, that's not the way for your role, what it is. You should be really having this resource or support, or you should really be looking at things this way. Or you're now in a position that's different than what you did before." You got to start sort of shifting, to have executive presence or to do those things which are skills to get success.

John: No, it's a really good point. Because we know how we feel in our internal talking to ourselves. When you have someone who's objective and really has no vested interest other than in your success, it's just a different perspective that just really can open your eyes. It reminds me too of something that one of my friends colleagues, advised me, and he was a hospital leader way before I was, and he said, "The next time when you apply for a job at one of these hospital systems or something, you should ask them to provide you with a business or leadership coach as part of your contract." I thought that was a brilliant idea. I never had the chance to implement that, but I thought that is a really good idea.

Dr. Nilesh Dave: Yeah, I agree. I had been told that after a year into the job that my company also provides that.

John: Okay. Nice.

Dr. Nilesh Dave: I was like, "Whoa, really? You guys actually provide that kind of stuff?" I'm very blessed to be in a company that really invests in their own people, with innovation programs for officers and things like that, to really understand the business. That was one of the other things that I went through as I was learning the company. They're like, "Well, we're going to throw you in this program for seven weeks." And I heard from all the strategy leaders, finance leaders, and it kind of fast tracked me in my education of just knowing where am I working at? What have been their goals? Where are they trying to get to? And how do I fit into that? And that's just investing in their people. Not every company does that kind of thing.

John: Yeah. That's awesome. It really is. I think outside of medicine, it's very common for large businesses to invest in coaches for their CEOs and senior leadership team, and even managers sometimes. We're a little bit over time here, but I do want to ask you any thoughts about AI in medicine? It sounded like you have some experience. Is this something we can ignore for a while or do we have to really start to learn about AI if we want to get into clinical or nonclinical future jobs?

Dr. Nilesh Dave: Yeah, I've been involved in my own current job and just reading and talking to different folks in the AI space. I think that some of the takeaways that I would say to answer your question is, one, the physicians and the healthcare teams that learn to work with AI as a tool are going to do better than those who say, "Well, I'm not getting into this. Or maybe reject the idea or think that it's a fad and eventually it'll go away." I don't think it's going to go away.

But with that said, the most important thing is understanding how do you evaluate a proper AI partner for your clinical operations? What they're calling AI, why are they calling it AI? How do they develop it? How do they test it? How is it biased? What's the risk that it can create harm? And that's a lot of the governance, sort of points that we set up. For anyone working in the hospital side, if your health system or your independent hospital doesn't have a governance structure, you need that.

Secondly, you need a framework to evaluate all the different vendors and folks that are going to come at you with, "Hey, we've got this cool thing." And you never know, it could be half baked. And they're just looking for a partner to use data to test it and iterate on it. Well, do you want to be that partner or do you want to wait till it's baked more?

But I think overall it's going to be a very helpful tool. We're using it, we're piling it in our outpatient clinics, especially generative AI. There are ambient AI programs that can listen to in a HIPAA secure fashion physician patient interactions and create a soap note or an APSO note and then you can edit that and clean it up a little bit. But it's screened by human and then sent to you very quickly so you can just focus on talking to the patient and not even need Scribe.

We have it being used in imaging, some of our business side, like revenue cycle. And so, we're looking at that, even looking at programs that will evaluate when patients call a hospital and have a conversation, what's the tonality and what is that doing from a business side? What's the engagement? What are they mad at? What are they telling us that we may not have picked up on? Because it's otherwise done manually. There's some cost savings potentially there, but in all of these, you want to have a governance structure to work through. Because data security is also a very important thing.

Yeah, you should get on to the bandwagon, but carefully I see. With structure, with a framework and see where it can help you the most. I think all these burdens and cumbersome tasks that have been attributed to burnout, there's an opportunity here to reduce some of that. Doing all your notes at the end of the day and all that stuff. There are tools out there that are good.

John: Yeah. Okay. Good to know. We need to embrace it at some point but also to make sure there are ways to monitor it and make sure it's safe and it's secure.

Dr. Nilesh Dave: Absolutely.

John: I really thank you for being here today. I hope the listeners get the same that I got out of it. It's very interesting and it's inspiring and it's also a lot of good points to think about and remember as maybe my listeners are pursuing a career in hospital management or any kind of management or leadership position. I know that we'll probably have some questions for you. I think LinkedIn would probably be the simplest way for people to reach out. I know they can just look up Dr. Nilesh Dave and they're going to find you. If you do have a question, those of you at home listening, then Nilesh can help you out.

Dr. Nilesh Dave: I'm happy to.

John: This has been really good. I'm going to have to catch up with you again in a few years. Maybe I'll have you come back, even maybe a panel on AI. Again, I'm just afraid it's going to become overwhelming very quickly. All right. Thank you very much for being here and with that I'll say goodbye.

Dr. Nilesh Dave: Thank you very much for having me. Happy holidays and happy New Year.

John: Thank you.

Scroll back to top

Sign up to receive email reminders, news, and free stuff every week!

Enter your name and email address below and I'll send you reminders each podcast episode, notices about nonclinical jobs, information about free and paid courses, and other curated information just for you.

powered by

Disclaimers:

The post What Makes a Great Health System Chief Medical Officer? appeared first on NonClinical Physicians.

4 Things the CMO Should Never Say to the CEO – 251

John Jurica — Tue, 07 Jun 2022 11:00:56 +0000

Effective Physician Leadership Notes

In today's podcast episode, I present my take on things the CMO should never say to the CEO.

These admonitions apply to anybody in management, not just the CMO. For reference purposes, the term “senior management team” refers to the CEO and all the CEO's direct reports. This includes the CNO, the senior VP for HR, the CFO, the COO, and other senior-level positions.

The principles I learned apply to any highly functional senior management team. Whether you’re an executive in a hospital, pharma company, insurance company, or other large corporation, these leadership concepts apply.

Many nonclinical positions involve management from the very start. But others (e.g., physician advisor, medical writer, or medical director) may not involve management at first. But it is quite common for physicians to move into management positions quickly because they are seen as leaders by others.

As a result, learning these principles can be useful for almost any physician, and other clinicians in alternative careers.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.

4 Things the CMO Should Never Say

There are probably many more. But here are things the CMO should never say because they reflect negatively on accountability and commitment to the success of the organization.

“We’ve tried that before and it has never worked.”

This is a common refrain of those who are unwilling to revisit old goals. But leaders need to accept the fact that goals that were formerly unattainable might now be possible with new technology, new ways of doing things or renewed energy and enthusiasm.

“I completed my assignments, but somebody else dropped the ball.”

This is a comment that would make us cringe. The COO, CNO, CFO, and CMO should never say these words.

A team member fails to complete an assignment and the plan does not come together as hoped. While that comment may be accurate, it demonstrates that the person making it is not a true leader. A leader is going to take the bull by the horns and get it done, even if it means taking on more responsibility or monitoring the other team members' progress and assisting them when needed.

It's not that you need to babysit everybody. The point is to get the project done. And a leader is generally the most proactive in helping others to meet their commitments.

“I disagree with the decision on this and I cannot support moving in that direction.”

The way it works on a good team, the leader of the team gives everybody a chance to chime in, and share their input. However, organizations are not led by consensus. Once everyone is heard, a decision will be made by the CEO or whoever is in charge of the project.

Then, even if you didn't strongly support it, or vehemently argued against it, once the decision is made, you must fully get behind the decision. And everybody should then work together to accomplish the goals of the project. If it fails, the team can revisit the other recommendations later.

“I’m sorry IF…”

There are apologies for doing something wrong, and apologies for making mistakes, but we're talking here about apologies for not doing what you said you would do. Everybody on a senior management team needs to be 100% accountable for doing what they said they would do, when they said they would, the way they said they would.

There should not be any contingency in an apology such as “I'm sorry if you don't believe that I did this properly,” or “I'm sorry if things didn't turn out okay.” That's not an apology. The word “if” should never be used. You must take ownership.

It should be, “Look, I'm sorry. I dropped the ball on this.” Admit that you made a mistake. Then, “I commit to correcting this and I will come back in one week and have everything that I committed to accomplished.” And finally, “This won't happen again.”

Apologize appropriately and keep your word.

Summary

There are certain things that any leader including the CMO should never say to the CEO.

If you're in a leadership position, you can undermine your standing by making one of these four blunders. It can be career-ending.

On the other hand, if you demonstrate integrity and accountability by not making excuses, not blaming others, not being defensive, and by apologizing appropriately, you'll be well on your way to being an exemplary leader.

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

EXCLUSIVE: Get a daily dose of inspiration, information, news, training opportunities, and amusing stories by CLICKING HERE.

Links for Today's Episode:

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

Email Download New Tab

Transcription PNC Podcast Episode 251

4 Things the CMO Should Never Say to the CEO

John: Now this week, I'd like to present a topic in what I'm calling my effective physician leadership series. I've done several other solo episodes where I talk specifically about leadership. So, I'm giving it a bit of a moniker here as an effective physician leadership series or effective physician leadership notes.

But I learned a fair amount about working in a complex management environment as chief medical officer for a 300-bed nonprofit standalone hospital, which I did for 14 years. And we spent a lot of time honing our skills as a team together to develop trust and to build a team that could really effectively run that hospital.

And I learned a lot. We had coaching. Our CEO had a coach. We as members of the senior's team had the same coach. And we did receive coaching as a group together. So, I did learn a lot that I think would be helpful to share with you. Many of you are in leadership positions or will be in leadership positions. Now pursuing a management or leadership career itself is a nonclinical or a nontraditional career for physicians, although many physicians do become leaders. I think also even if you start as a medical writer, an editor, or something in utilization management or any other alternative type of career, you will have opportunities to take management and leadership positions. And so, you should probably learn these principles if you don't already know them.

Now, whether you're a CMO in a hospital, pharma company, insurance company, or other large corporation, these concepts will definitely apply. But even if you're not, if you're running a smaller organization, if you're an entrepreneur and you're trying to grow your business, you're going to need these kinds of skills. And if you're in a lower management position such as a medical director, by demonstrating these leadership skills that will lead to you being recognized and considered for more of a leadership position. So, you have to demonstrate these kinds of skills early in your career. And that's what enables you to move up. Because in violating these leadership principles, you will be passed over because it'll be obvious that you're not ready for that kind of a position.

And when I decide to address a topic like this, sometimes it's more fun and instructive to look at it from the perspective of what not to do. I know I've done a presentation on eight big mistakes to avoid while pursuing a nonclinical career. That's one example, but it can be useful to do it from the perspective of things not to do, the common mistakes to avoid. And so, with that, let me describe the four things the CMO should never say to the CEO.

Before I get into the four things, I want to remind you of a couple of things. First, these apply to anybody in senior management. So, it's not just the CMO. It could be the CNO. It could be the senior VP for HR. It could be any of a number of senior-level positions, but these are the things that you don't want to say or express even to the rest of the team because it'll show that your leadership is failing.

Now, let me define what a senior management team is. And basically, when I use the term, I'm referring to the CEO and all the CEO's direct reports. So, I'll use a hospital as an example. In a small hospital, such a team may consist of the CEO, the CFO who sometimes also serves as a COO, the VP for HR, maybe the chief nursing officer, and there might be a VP for ancillary services who covers all of the lab testing and respiratory testing and imaging because it's a small organization. So, there might be five or six in that senior management team.

A larger hospital might have those positions, plus the chief operating officer, plus a VP for strategy or strategic initiatives, maybe a VP for post-acute services, and a CMO. And then the larger organizations might have those plus others like the chief legal officer, or the chief academic officer if it's an academic institution. The chief medical information officer might be a separate position and or a chief quality officer. But you get the idea.

The senior management team will consist of 6 to 12 members setting the vision and strategic direction of the organization under the leadership of the CEO and the direction of the board of directors or trustees, depending on if it's for profit or not for profit. And so, the execution of the strategic and management plans that are developed by the senior management team is done at the level of the directors and the managers, and the frontline employees. They're the ones that actually run the hospital per se day to day. But the role of the senior team is to be certain that each of the component parts does its job, follows its budget, and coordinates with the other components to meet its mission.

And the other thing I want to comment on here is counter to what some may believe. Each senior management member should be committed to the success of the organization as a whole, and not just the success of his or her own division. That's really one of the highlights or the hallmarks of a truly effective senior management team. You don't consider the people reporting to you to be your primary team. It's your team, but your primary team is the team that you work with on a day-to-day basis to coordinate all of the functioning of that organization, meaning your senior management team. And you'll sometimes have to give up certain resources to help the other parts of the team succeed so that the organization can succeed, even though it may take a little bit away from your part, your division, let's say. So, I wanted to mention that.

Given all that, here are four things, there are probably many more, but there are four things the CEO does not want to hear from any member of the leadership team.

One is this. "We've tried that before, and it has never worked." This is something I heard a lot when I was CMO, but it was usually from team leaders, managers, and physicians. And it's a way to try to stall things. It's a way to get stuck. Sometimes it's due to a fear of change, fear of doing things in a different way. Sometimes it might be that people really actually believe that, but it's usually because the stakeholders, whoever's in that group, again, whether it's a department or a part of a department, they don't want to try something new. They don't want to change the way things are done now because they've got it down, it's routine, they can handle it and it's not challenging.

I'll give you an example. We knew at our hospital at some point that several new things were coming down the road. For example, hospitalists. We knew that was a type of service that ultimately would be coming to our hospital because it was growing across the country and there were good reasons why it was growing.

Another was the institution of an observation bed unit. And the fact that the observation unit should be staffed by dedicated physicians. So, let me take that one. We, for several years, tried to create an observation unit because with Medicare changing its rules, it was saying that it would not accept having certain patients admitted to the hospital, particularly if they weren't going to be staying for more than a day or two. That by definition, meant they should be an outpatient.

And so, we tried several different ways over several years to make that happen. And we constantly would hear that "Oh, we tried that two years ago and it didn't work. The patients weren't treated well or the outcomes weren't good or the physicians were losing patients." There are lots of reasons, but this is a common thing that you hear when you're rolling out something new. It's that "We've tried that before and it's never worked." This is something that if I heard one of my directors say, it just drove me nuts, because look, there's a reason we're discussing this. There's a need that exists. And we are here as leaders of this organization to find out how to come up with a plan to discover how, or to make it happen, that this has to be addressed.

And in the observation situation, we had a lot of denials and we were actually writing off a lot of care because we would just keep patients in the hospital. And then we would after the fact change, convert the inpatient to an outpatient and not charge anybody anything, because patients weren't really being told that that's what was going to happen. The bottom line was, ultimately, we had to come up with a plan. We had to work together and make it happen.

And when you heard that comment, "We've tried that before, and it's never worked." That is basically looked at by the CEO and the other senior management team members as just dragging your feet. We can acknowledge that that's true, but that means we just didn't implement it the way we should, or we need to come up with a new way to implement it. So, that's the first, this is probably not the biggest one of the four I'm going to discuss, but it's an important one.

Now, by the way, these kinds of comments usually come up in the following setting, at least in my experience. Organizations generally have regular meetings of the senior executive team. That's one way they become a team is because they're constantly communicating directly and working together. Now they might meet by Zoom call more than they did before, but our team met in person at least weekly. And we would have a two-to-three-hour meeting. And some of them were devoted to strategic issues and some were devoted to operational issues and sometimes they would overlap. But we were face to face addressing these issues and hearing these comments sometimes maybe when we shouldn't have, but that's when they would be called out and then we'd learn. At those meetings, we're constantly planning and tracking our progress forward on management goals that we had set at the beginning of the year. That always meant that there were multiple people getting together that reported to us to work together to get these different projects going and completed.

So, this is a comment that we sometimes heard that would make us cringe. And that is on reporting back on their project, which we usually had a team working together. One of our members would come back and say, "Well, I completed my assignments, but it's still not done because somebody else dropped the ball."

This is one of those comments where you're assigning blame to somebody else because something didn't happen. I had managers and directors that would say this. Again, it would just kind of drive me crazy and I'd have to call them on it because it could be phrased in a different way.

But being phrased that way just doesn't sound good to the CEO or anybody in charge for that matter. And it doesn't sound good to the board if the CEO uses that comment. And a good CEO, never would. Even though I might be on a team as a monitor or maybe even chairing the committee. Let's say we're putting in place something like a new service line. And we have people from the lab and we have people from the pharmacy and we have people from nursing and people from credentialing all together. And one of my directors might come back to me after we had gone through a great planning process and we have these Gantt charts that tell us when things are supposed to happen and what each person is supposed to do.

And one of my directors would come back to me and would say, "Well, I had all my work done last Thursday and I knew we were getting back together early this week but somebody else dropped the ball. If it hadn't been for so and so, well, this whole thing would've been done by now. I just don't see why they can't do their job." Then I might ask my director, "Well, did you do any kind of follow up or did you reach out to find out what was happening along the way? Maybe you could provide them with some support." And then the director's comment would be something like, "Well, no. We each had our own work to do. I'm not their supervisor and I'm not their babysitter."

I think these things happen all the time because somebody drops the ball and then things fall through the cracks. While those comments are basically accurate, what that shows in that person is a great lack of leadership because the leader in this group, whether they're a chair or not, is going to take the bull by the horn and they're going to say, "Look, I've got my part done. I'm reaching out to the other members of this team. Hey Mary, did you get your part done? And if not, how can I help you? Joe, did you get your part done? Because I want to go back. We're all getting back together in a few days and I want to make sure that my VP is pleased and that we've done our job as a subcommittee on this team to get this part done."

I can tell you that there are employees that will argue at this point to the end of the Earth saying that as long as they're doing their job and they're part of the job, then they're a good employee. But that is a person who's going to be in that management position forever because they're never going to advance to be a leader. And so, that's why I'm telling you that I should never hear that from you if you're in a potential position to be looked at as a leader.

So, it's not that you need to babysit everybody. The point is to get the project done. It's not really important who does what work per se, but it'll become apparent who does what work and the people that are doing the most work and taking the most leadership, which means being the most proactive in getting things done, it will get advanced in that organization. If you want to just be someone punching a clock and making widgets, then so be it. But if you want to be a good manager and a good leader, then you need to be proactive. And when the project doesn't happen, it doesn't matter whether you did all your part, the project didn't happen. You are part of the team and you failed the team.

All right, the next one. Now this one, you don't hear a lot, but every once in a while, you might hear someone say something to this effect. "I disagree with the decision on this and I cannot support us moving in that direction." In other words, I bring this up because there's a situation, an understanding that when you're a member of a senior management team, you have to understand that sometimes decisions are made that are not going to be the exact decision that you would make in that situation.

But the way it works is that in a good team, the CEO or whoever's leading the particular team gives everybody a chance to chime in. And generally, to make that happen, you have to be proactive and you have to elicit responses from everybody in the room. Because you can make a situation where the team doesn't work cohesively because only two or three people pipe up. We always had people on our team that were very vocal. They were very extroverted. They always had opinions. They could hear something and then within three seconds they had an opinion.

Now I'm the type of person that needs to think about things. So, I would come back a week later sometimes with a really serious consideration on a topic we were discussing. And I always felt bad that I couldn't be more spontaneous, but that's just the way my brain works. I need to think about things and then come back with my thoughts rather than just my knee-jerk reaction, which may or may not be valid.

But we definitely had people on a team who always had an opinion and that's fine. But the CEO was pretty good about saying, "Okay, now I want to hear from Pete and now I want to hear from Sarah. And now I want to hear from everybody." And that's another sign of a good leader by the way. A leader will elicit input from everybody, even those who are not naturally expressive about their opinions.

So, the point on this is that none of these organizations are run by consensus. None of them are really a democracy depending on how you define that. Somebody has to make the final decision ultimately. Now sometimes you all may come to the same conclusion on your senior management team and say, "Yeah, this is fantastic. We came up with a great plan. Let's do it."

But a lot of times you're going to have disagreements about the best approach or when you're selecting a strategic initiative you might have to choose from among two or three, and you're going to be fond of one and somebody's going to be fond of the other. They're feeling it's the best thing to do, but it can't all happen. You have a budget. You can only spend so much this year. So, one thing's going to have to be put aside. And when you're in a team like the ones I'm talking about, everybody has to fall in line once a decision is made.

We assume that the decision, whether it's a board decision or a CEO decision, that the decision is made for the best of the organization. And it's not always a hundred percent clear, which is the best way to go. But the thing is with a team in order to trust one another and to work collaboratively going forward, what the CEO is going to demand, what the board is going to demand is that everybody gets on board with the plan.

Even if you didn't strongly support it, and even if you vehemently argued against it, that's fine. And everybody should have that input on that senior management team. That's what that team is for. To inform the CEO, to challenge the CEO. The CEO is usually going to have an idea of what they want to do and why it's the best approach. Just like the chair of any committee or team is going to have their opinion. They're going to come to a meeting and ask your opinion and your input, but they're going to have what they think is the best approach to take.

But the thing is until they hear from everybody on that team on that committee or on that senior management team, they don't really know everything. And that's why they need to be challenged because they may be working off assumptions that aren't a hundred percent accurate or that might be missing something. Again, the idea here is not that you can't disagree, you can, but it's the second part of the statement stating "I cannot support moving in that direction." The whole statement is "I disagree with the decision on this and I cannot support moving in that direction" or something similar.

And the point here is that once you've all had your say, whoever's making the decision, makes a decision, and then everybody gets behind it 100%. Then one of several things can happen. It's going to go great and it's going to be wonderful and the outcome is going to be just like everybody wanted. And that's good. Or it's not going to work or it's going to partially work. And then you just learn from that. And then you redirect and, in the case where there are multiple competing projects, well, then next year we'll do your project once this one is going.

But you don't remain as a squeaky wheel or a thorn in the side going forward once a decision for one of these big plans is made and we're moving forward. So, let's say we decide we want to do a hospitalist program, and the CMO myself, or maybe the CMIO or some other advisor says, "I don't think it's a good idea. The doctors aren't going to like it. The patients aren't going to like it." Okay. Give us the information, the support, the evidence. We'll discuss it, we'll consider it. But if we decide to move forward with it, then you're going to need to help us institute this hospitalist program.

Enough on that. The last statement I would say, the last thing the CEO doesn't want to hear from the CMO or anybody else on the team is, well, here's the short version. "I'm sorry if..." This is really just a comment on how to be accountable and how to apologize.

Now there's apologies for doing something wrong, apologies for making mistakes, but I'm talking about really apologies for not doing what you said you were going to do. That's one of the things. You need to be accountable. You need to keep yourself accountable. Everybody on a senior management team needs to be one-hundred percent accountable. Now, we're human and things can fail and falter, but the expectation by the CEO and by all the other members of the team is that if you say you're going to do something, you're going to do what you said you were going to do in the timeframe you said you would do it, the way you said you were going to do it.

Now, most people don't care too much about the way that you do it. But again, you're in a meeting. You've got a big project going on. Each of you has your part of that project. Let's say that as a CMO, since the pharmacy reports to me, the part of the project that depends on the pharmacy and the pharmacy director then is my responsibility. And I'm in a meeting. And I said, "Yes, we were going to deliver this protocol and set up the use of this medication for let's say this new unit. And that will be ready to go when I report back here in two weeks."

Then let's say two weeks rolled around and I got sidetracked. I let the ball drop and then it's my time to be accountable. Part of that is admitting that I didn't do what I said I was going to do. And that's where the apology comes in. But this is true of any kind of apology. There should not be any contingency in the apology like "I'm sorry if you don't believe that I did this properly or I'm sorry if things didn't turn out okay." That's not an apology. The word "if" should never come in there. You have to take ownership.

In this case where I didn't deliver the pharmacy protocol and maybe get the meds and get things cleared by the pharmacy and therapeutics committee and all those other things, there should be no "if". It should be, "Look, I'm sorry. I dropped the ball on this." That's number one, admit that you made a mistake. Number two, "I commit to correcting this and I will come back in one week and will have everything that was expected of me for today. And it'll be in place and it'll be ready to go. By the way, this won't happen again."

That's really part of a good apology. And unless you know how to apologize appropriately, you can't be a good leader. So, you're going to accept what went wrong, that it was your responsibility, that you're going to correct it usually within a certain timeframe, and that it won't happen again. This is pretty concrete and becomes a way to identify those members of the team that need to be let go.

If there's a member of the team who simply cannot keep their word, continues to commit to things that they don't complete, then makes mistakes, and then doesn't apologize appropriately, then they're not really worthy of being an ongoing member of that team. And take the steps needed to eliminate that person from the organization. And that's true of working with people in any business. So, if you're an entrepreneur, if you're a consultant, whatever it might be, you definitely want to follow that process with people that are reporting to you.

Those are the four statements or four things that the CEO doesn't want to hear, or four things that the CMO should never say to the CEO or their senior management co-members.

If you have any questions, feel free to contact me by email at john.jurica.md@gmail.com. If you're in a leadership position, you can really undermine your standing by making one of the four big mistakes I mentioned today. On the other hand, if you demonstrate integrity and accountability by not making excuses, not blaming others, not being defensive, and by apologizing in the appropriate manner when it's warranted, you'll be well on your way to being an exemplary leader.

Scroll back to top

Sign up to receive email reminders, news, and free stuff every week!

Enter your name and email address below and I'll send you reminders each podcast episode, notices about nonclinical jobs, information about free and paid courses, and other curated information just for you.

powered by

Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you.

The post 4 Things the CMO Should Never Say to the CEO – 251 appeared first on NonClinical Physicians.

6 Important Assignments of a Hospital CMO – 218

John Jurica — Tue, 19 Oct 2021 10:00:03 +0000

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.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.

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.

Summary

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.

Links for Today's Episode:

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

Email Download New Tab

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.

Scroll back to top

Sign up to receive email reminders, news, and free stuff every week!

Enter your name and email address below and I'll send you reminders each podcast episode, notices about nonclinical jobs, information about free and paid courses, and other curated information just for you.

powered by

Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you.

The post 6 Important Assignments of a Hospital CMO – 218 appeared first on NonClinical Physicians.

How to Go from Retirement to Ardent CMO and Medical Expert – 189

John Jurica — Tue, 30 Mar 2021 10:00:23 +0000

Interview with Dr. Dan Field

In this week's interview, Dr. Dan Field explains how he went from retirement to ardent CMO.

Dr. Dan Field is the chief medical officer for MDstaffers, recently ranked the 49th fastest-growing company in the United States. There, he oversees all clinical staff operations and quality assurance. He also oversees the Medical Expert staffing component.

Dan is a board-certified emergency medicine physician who practiced for more than 30 years. He serves the California Medical Board as an expert reviewer and consultant.

He is an expert witness for cases involving personal injury, criminal law, standard of care, and malpractice, and is a featured speaker, panelist, media physician, and talk show guest.

Dr. Field received his medical degree from the University of California at San Francisco, followed by an internship at Highland Hospital in Oakland. He then completed his EM residency at University Hospital in Cincinnati.

Our Sponsor

We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.

The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.

How to Go From Retirement to Ardent CMO and Medical Expert

Dan points out that most of us do not truly retire. We may phase out of clinical medicine, which can be intense and emotionally draining. However, by applying transferable skills, we can often move from retirement to ardent CMO or another equally rewarding position.

I advise you to listen as Dan talks about how he pursued interests that satisfied his desire for autonomy, variety, accomplishment, and reward. And he notes that humans are not made to BE happy but, rather, to PURSUE happiness.

Stacking New Skills

Then he provides practical advice about stacking new skills to prepare for your next career. A pertinent example he provides is to work as a state medical board reviewer to gain experience before embarking on a medical expert consulting business.

I think building a skill stack it's like opening up your tool chest and putting tools in it that are going to be useful to you. – Dr. Dan Field

We cover two important topics today: preparing for the transition from retirement from medicine to your next career, and how to prepare to do medical expert consulting. One way to learn necessary skills and find your first clients is to join a company such as MDstaffers.

Summary

I have no financial relationship with the company, but I think exploring MDstaffers at mdstaffers.com is a good place to look for locums jobs and medical expert witness consulting engagements. And from what Dan says during our discussion, he or one of his colleagues can help you to prepare to get started.

NOTE: Look below for a transcript of today's episode that you can download or read.

Links for Today's Episode:

Download This Episode:

Right Click Here and “Save As” to download this podcast episode to your computer.

If you enjoyed today’s episode, share it on Twitter and Facebook, and leave a review on iTunes.

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

Email Download New Tab

PNC Podcast Episode 189

How to Go from Retirement to Ardent CMO and Medical Expert - Interview with Dr. Dan Field

John: I'm always looking for chief medical officers who don't work in the hospital setting. So, I'm really glad today's guest is here. And it's kind of a twofer because we're going to talk about his career as a CMO and talk about the company that he works for, which also provides opportunities for expert witness and other types of clinical, but some nonclinical. So, with that, I'd like to welcome Dr. Dan Field to the PNC podcast.

Dr. Dan Field: Good morning. Looking forward to our time together today, John.

John: I'm really looking forward to it because again, I use the term CMO. It's kind of like the term medical director. It just can mean almost anything, but the one thing it does mean is it's a physician. So, tell us a little bit about your clinical background. I've done a separate intro with a lot of the details, but if you want to give us a little bit about your clinical background and then how on earth did you sort of segue into this role as a CMO?

Dr. Dan Field: Okay. Well, I started out as a Kaiser baby and I went to medical school and came back and became a Kaiser doctor and now I'm a Kaiser retiree. So, in that time I did my premed at Irvine and Edinburgh University. I did a little diversity there. Medical school in San Francisco. And I finished up with an emergency residency in Cincinnati before returning home to California.

John: All right. And you did that for a few years, correct?

Dr. Dan Field: Correct. Yes.

John: And a lot of things along with it, right?

Dr. Dan Field: Yeah. Yeah. So, I did 30 years in the emergency department and when I say it like that, I feel like I'm saying I did 30 years in prison. But during that time, I kind of was trying to list some of the things that I did to kind of break out of the standard operating procedure. So, I ran for office, I started a manufacturing company. I engaged in a medical startup. I built a solar-powered home. I became a demo doc for a major CPOE company and I became a deputy sheriff on the SWAT team. So, I tried a variety of things.

John: Oh man, we're going to have to like have another three podcast episodes just to go into each one. But now that's a pretty broad spectrum of things. Now, did you actually completely retire and then kind of search out the CMO role? Or was this something that came up while you were still practicing?

Dr. Dan Field: It took retirement to find it. And it's kind of as serendipity. I was heading towards retirement, and I must have clicked on an advertisement. There are all these online things being thrown at us. And this one probably said something like work in the wine country, $200 an hour. And that probably went into a database and a nice young man, reached out to me and said, “Hey would you like to consider these things?” And he kind of took me by the hand and brought me back into some clinical because that was the contact locums. But then it turned out they had a spot open for a CMO and after our engaging conversation, he said, “Why don't we think about you joining us as a CMO?” And then I said, “Well, I have this idea for a med-legal panel”. And he said, “Well, let's see, we could call that MDexperts”. And we have a hundred thousand doctors in our Rolodex. So, if somebody needed a specialty, wow, we've got it.

So, serendipity led to the situation and I should say, the things that really made it work, is that I personally had a low barrier to entry. I did not say you need to start out with a quarter million or $300,000 a year and no defined value. So, I came into it with the attitude that I was going to create my own value stream in this situation because MDstaffers was a tiny company at the time. And they were rapidly growing and I was right there at the beginning, but there wasn't a way to really pay me out of sales or commissions or so forth. So, I developed a value-added stream sort of approach.

John: Okay. So that means this is kind of like a unicorn or a black swan event, I guess. But I've heard of actually many other physicians who either they're interested in startups, or after retirement looking to be on a panel, to be an advisor. So, in retrospect, MDstaffers looking at it online, it looks like it's into a lot of things. It looks like it's got a lot going on, but you're saying it was pretty much in the early stage when you found them and they found you.

Dr. Dan Field: Yeah. So, they had been growing steadily, but actually, with the advent of the pandemic, our mission is to plug the holes in the healthcare system, the manpower gap. We work mostly with physicians and advanced practitioners and now we do mental health as well. We all know there's a huge gap and it's our mission to fill that. And suddenly with the pandemic, we had a lot of doctors actually being idled, which was a stunning outcome of that to all of us and a need to shift to online health care. So, it was another serendipitous moment.

John: Yeah. When you look at companies like this recruitment and related things, it's always a chicken and egg. You need the bodies and you need the jobs and what do you get first and lots of companies just die because they can't do it. So, there you were, just boom. All of a sudden, we had a lot of people that were ready to look for something. And so, you could just soak that up as you built more and more opportunities. That's fantastic.

So, looking back, what kind of advice could you come up with in terms of someone who thinks “Wow, that sounds pretty interesting. Is there any method to the madness? How can I possibly try to do the same thing?”

Dr. Dan Field: There are so many ways of approaching that. And with our limited time, I'm trying to distill in my mind. I think that you have to know what it is that makes you happy, or at least satisfied. And keep in mind, we are not made to be happy. We're made to pursue happiness. But happiness never occurs. So, it's the pursuit. Now in that pursuit, what makes you feel the best? What tickles your brain and gives you a certain amount of joy and enjoyment? So, I think it's autonomy, variety, accomplishment, and reward. I think those are the four things that tickle my brain the most and give me the most satisfaction. So, something that gives me the autonomy to be able to get up in the morning and go for a run before I settle down, or get up even earlier and do some hard cognitive work and then go for a run and come back and do some more.

So that kind of autonomy, the variety. I'm coming at it from clinical ops, I'm doing med-legal, I'm doing clinical work, variety accomplishment. One of my biggest satisfaction moments came when I built my house because there it was, I did that. I did something. I brought all these parts together and I made something.

And then, of course, reward. Getting some money for what you do. Having people say, “Hey, doctor, you made a real difference on my LinkedIn”. It's especially rewarding. It’s ridiculously rewarding how pleased I am to have somebody just say like, or insightful, or go beyond and say, thank you for stepping out there and making these comments. So, my reward comes from so many different directions now.

John: Yeah. Well, people sometimes call it a purpose or passion and other rewards, but you're right. It's the journey, not so much like you've landed there. But I like you talking about your house because they have a physical representation. That thing is done. We don't always have that in medicine because our patients go away, they get better, they get worse. But if I could build a guitar or build a house.

Dr. Dan Field: Exactly, that's exactly right. Even a well-crafted medical-legal opinion to me where I took an issue. I refined it. I researched it. I made points. I justified those points and I presented them. That is something that's concrete. When I worked in the emergency department and I see the same person for a drug overdose three times, I don't feel like I've made a lot of progress there.

John: Yeah. Really, I can remember those experiences in my office as well. It's frustrating. That's kind of the patient you hate to see. You look at your schedule, you didn't have a schedule to look at, I'd look at a schedule and see the person who was coming back in two hours.

Okay. So, we're going to move to the meadow medical expert in a minute, but I want to ask you because I think this is an interesting transition. Physicians aren't really going to retire. I mean, they might retire from clinical, but our minds are going, we have energy, we have so much knowledge. Do you think that most physicians that practice as long as you did and that kind of environment, whether it's internal medicine, emergency medicine surgery, do you think we should pick up a few new skills at the end of that to anticipate this next? Should we do little pilots or do we have enough of the knowledge and skills that are really going to translate into some other jobs already?

Dr. Dan Field: I think preparation is the way to go. I think building a skill stack it's like opening up your tool chest and putting tools in it that are going to be useful to you. So, I knew that I liked med-legal. For some reason, I was attracted. In fact, when I applied to medical school, I applied, my thought was to do an MD/JD. That was 35 years ago. And it was too startling for most of the medical school admissions committees. And I didn't get accepted when I led with that. But I knew I liked it. And so, I began to add tools along the way. Kaiser doesn't allow you, TPMG, the Permanente medical doesn't allow you to do outside work for a monetary reward if it involves your license. But what they do allow you to do is public benefit.

So, I actually started working as a California medical board reviewer, and here they're asking us to look at medical cases and say was the standard of care met? Was there an education deficit? And I began to develop the evaluation capacity, which actually translated very well to my next stage as an expert witness.

John: Yeah. I think you don't always know where those are going to go, but those extra experiences can be very helpful. Not only because you've learned new skills, but then when someone's looking at you, they say, “Oh, wow, that's something interesting that might be useful for what we need”. So now, from what I understand when you joined MDstaffers and they had never had a CMO. They were small enough that they have a similar position.

Dr. Dan Field: They did have a CMO previous to me. It didn't work out the way they wanted it to and there was a parting of ways.

John: Okay. So, then there you are. And then you were the one I think that introduced this concept of adding the MDexperts to their growing kind of array of topical areas. So, tell us about that. I know you have that interest, but tell us how that transpired and what it is today.

Dr. Dan Field: Let's go back a step to MDstaffers business model. So, they have two clients. They have physicians and advanced practitioners, and that's one group of clients. And on the other side, they have the Adventist selves or the major healthcare organizations who are looking for manpower or person power support.

So, we are recruiting on the one side for those big company clients who need volume and we're prospecting for the workers on the other side, and then we're going to match those. They might say, we need a hundred mental health care workers for our telemedicine product. And we'll say, okay, are you ready for a hundred of them next week? And we've broken the bank there, or the processes for some of our companies because we give them so many high qualities. Well, we now got a hundred thousand plus physicians in our Rolodex and it takes an older person to know what a Rolodex is.

The concept is really simple. Somebody needs a specialty in Hackensack, New Jersey. And they call us up and they say, “Who do you have in Hackensack who is a pediatric pulmonologist?” So, we just go into our tracker database and type in 50 miles from Hackensack and a pediatric pulmonologist. And I get four names and I have the CVs. I have everything ready and we shoot them a CV and they say yes. And then we match the two.

John: What's the experience for the physician? Are they a subcontractor for you and MDstaffers or directly for the attorneys that are looking for them or the insurance company or whatever it might be? How does that work?

Dr. Dan Field: Well, that's a good question. In many of these circumstances, it's a handoff once the connection is made and somehow the value has been extracted before that stage. And then it's up to the physician to work out with the requester. Our model is that we manage the process. We do the invoicing, we guarantee the payment, we pay the liability in this case. And in exchange, we take a less than typical market share. So, it'll be less than 30% for our margin. So that's the model.

John: Do you have a sense of the physicians? Do you get many physicians starting out that haven't done this before and contact you about signing on, or do you generally use more experienced people or both? What feedback do you get from the physicians that are involved?

Dr. Dan Field: A lot of physicians come to us through the recruitment process. So, on MDstaffers side, where we're talking to them and we're engaging in conversations, our recruiters are really good, and we really develop a nice relationship with their doctors. And along the way, we say, “And by the way, are you interested in this line of work over here?” And a high proportion of the people that we talked to say, “Yeah, yeah, I might like to do that, but I haven't had any experience”. Well, we have a little process that we go through to help them begin to build the experience. And in those cases, you can volunteer for your in-house quality assurance committee. You might get paid for that in-house, and you begin to build some variety inside your current practice, which is a very nice longevity tool because again, variety and autonomy and reward.

So, you begin to build some of those inside your current lifestyle. You reach out to your medical board and see if they have a reviewer program. You touch bases with the public defender's office. They're dying for experts, but they can't afford them. And so, we created a government rate basically to help the justice system, and it's much lower than the commercial rates, which we charge at-large criminal product, liability, and so forth. And that is beneficial to society and its benefits to us because it builds experience and volume. So, that's what I tell the new physicians. I say, take them through this route.

John: I had a conversation with one of my colleagues who does a lot of telemedicine. He's licensed in multiple states. And he said that he had discovered that many of the state licensing boards need physicians to review records, review quality, review complaints. So, you're saying that kind of thing could set them up to take the next step and move maybe more directly into an expert witness type of activity.

Dr. Dan Field: Yes. And since a lot of physicians are not looking to leave clinical practice entirely, they're trying to build a side gig inside their current lifestyle, where they can take some of their non-program time and turn it to a monetary reward and then perhaps reduce their clinical. And as we all know, when you reduce clinical, you reduce exposure.

John: That's a good part.

Dr. Dan Field: Well, it's a great part. And it has two parts to it itself. This is a little segue, but not only are you reducing your personal exposure, but the very act of studying these things teaches you how to avoid exposure. So, it's a total win-win and perhaps triple win situation.

John: Yeah. I guess if you're gaining expertise on how to be an expert witness and then you know “Oh, my documentation needs to be spruced up a little because obviously, this is what they're asking me to look at”. Or if you happen to go through a deposition, you learn those things pretty quickly.

Dr. Dan Field: Okay. So, let me throw one more thing at you along these lines, because you were asking how we prepare our new doctors for this kind of career. Another thing is just an education on what an actual expert witness is and does. So, we all have kind of our TV imagery. Yep. But what is the reality? And my reality is that I have found that I am an interpreter. That's how I look at my expertise as that of interpretation.

So, I take a medical record and other information that might be confusing and are out of the area of expertise of the judge, the jury, and the attorneys. And I interpret this for them in an ethical, and, what would be a good word? It's somewhat of a blinded fashion. I kind of walk into these cases without a preconceived notion or with the openness that my preconceptions and biases might be changed by the facts of the case. And that happens a lot. I had a great case with the Air Force, where I went in thinking “This guy's a scumbag and I'm here to defend him”. And in the course of the case, it turned out not to be in my opinion. So, you were an interpreter.

John: Now, what I've heard others ask about as well, “How much actual record review am I doing as opposed to actually ended up doing a deposition? And am I likely to ever end up in court in a trial?”

Dr. Dan Field: The answer is no.

John: It's pretty rare.

Dr. Dan Field: Yeah, just like with malpractice cases, mostly favoring the physician. Probably 95%, something like that. That same applies to your chances of actually getting into the court. So, I've probably reviewed a hundred cases by now. Not huge, maybe even 200. And I probably made it into court a total of 15 times, and I love depositions. I love sitting in court. I love that part of it very much. I don't like malpractice. I don't think anybody does, but personal injury and criminal is really nice because I go there as a nonpartisan and I'm here to help and advise.

John: No, I think that's a good picture of how things go. You have to have a certain personality, I suppose. You can't be a hothead that flies off the handle. You have to be able to listen, stop and be calm basically, and give a measured response. But if you can do that, I mean we're well-trained, we should be able to do it in most cases. So, I think it's something that practicing physicians rather than just, say, dumping clinical completely, maybe cut back on the clinical because you need to stay in clinical if you're going to do this anyway, most likely because they want you to know the standard of care. And do this. It's a good side gig. And like you said, it could balance out things.

Dr. Dan Field: Variety and reward and some autonomy. You know what? You really hit upon it, John. I think you were touching on a valuable tool - You need to be a team player. And think, for instance, a physician such as yourself, a family practice person, perhaps with an office or a team, have some nurses, you have an assistant. They're your team and you're working with your team to bring about an end. And when you are an expert witness, you're part of the team. You're not house. You're not the prima donna that everybody's going to come and bow to. You are part of the team and you're working to get to the end to go deliver a product.

John: So, if I was interested, I could get on the phone and call MDstaffers, MDexperts, and just talk to somebody about what it would take to become one of your physicians that do that. And if they have to do some other work first, that's fine. But at least I can learn more about how to get there.

Dr. Dan Field: I'm happy to talk to anybody who wants to discuss this. I've benefited from those who have gone before me. And I will be paying it forward as the phrase goes and helping the people along the way. I’ve got some good ideas for them.

John: All right. I want to remind everyone that the website is mdstaffers.com. That's one word and everything that you've talked about and everything that MDstaffers does is somewhere on that website. And there's probably a contact form to reach out if you'd like to do that. Is there any other thing? Like the mention about MDstaffers, you say you've got a locum’s component as well. So, a lot of people use that as a temporary or permanent change from what they're doing.

Dr. Dan Field: Yes. You should keep in mind, those of us who are near retirement. And if you think, “Well, I might take a couple of years off and travel to Fiji and Bora Bora” and so forth. At least in emergency medicine and probably the same for surgery and some other areas. If you haven't practiced in the clinical setting in the last 18 months, you're out. The process to get back in and to get on staff becomes much more onerous than people would consider.

So, I really advise people to keep their foot and their toe in the bathtub here and keep a little side clinical going. And that can extend your career until as long as you want it to go. I frankly don't know what I would do if I didn't have this to get up to every day. I mean, I could not sit there and read the paper and drink coffee all morning, and then go meet my buddies at the coffee shop for more coffee. I need more than that.

John: No, everyone I've talked to, I haven't really seen a physician. Most of us either practice till we drop, or we do something else. And that's healthy. You need that, I think. All right, well, we're going to run out of time here. So, I guess I would ask you if you have any other advice, maybe for a physician who's maybe not quite ready for retirement, but thinking about those few years down the road. Any specific advice or other comments you would have for us?

Dr. Dan Field: Yeah, yeah. Realize that failure equals experience. Don't be afraid to go out and try something. You're going to learn. You're going to learn as you go. So, when I went out and worked in the business world, I learned some business concepts and I learned how important it was to be a team player. Don't quit your day job. Find a way of diversifying your day job internally and pick up skills so that you have something to offer when you get out.

I think you should try to find out what tickles your brain and then make that the direction that you're going to move. So, you're going to build your skillset around those things that bring you that happiness or satisfaction. And there are ways to do that by taking baby steps. So, I'm an incrementalist. I like job security and a paycheck, so that's my advice.

John: All right, Dan. Well, this has been very interesting. We've learned a lot about the two major topics that I think we're going to be able to learn from and apply. So, I really want to thank you for spending the time. Again, that's mdstaffers.com. I'm sure they can track you down there, or you can go on LinkedIn and probably get a hold of you and contact you that way.

Dr. Dan Field: Absolutely.

John: All right. Well, with that, I guess I'll just have to say goodbye.

Dr. Dan Field: Okay. Thank you.

John: You're welcome. Bye-bye.

Scroll back to top

Sign up to receive email reminders, news, and free stuff every week!

Enter your name and email address below and I'll send you reminders each podcast episode, notices about nonclinical jobs, information about free and paid courses, and other curated information just for you.

powered by

Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you.

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career.
The post How to Go from Retirement to Ardent CMO and Medical Expert – 189 appeared first on NonClinical Physicians.