By Christopher Cheney
Executives at the HealthLeaders Chief Medical Officer Exchange last week discussed a range of high-priority topics impacting their health systems, hospitals, and physician practices.
The HealthLeaders Exchange program features peer-to-peer interactions to address industry challenges. The intimate conference format of small-group breakout sessions encourages open conversation and deep networking.
This year’s CMO Exchange included vibrant discussions on four topics.
1. Post-COVID environment
Tracy Breen, MD, chief medical officer of Mount Sinai West in New York, New York, said health systems and hospitals are emerging from the emergency phase of the coronavirus pandemic.
“Our challenge is moving past just surviving and into thriving. The first year and a half of the pandemic, it was about survival. Now, we have to find ways to thrive even with The Great Resignation. We need to bring joy back to work. We need to bring purpose back to work. Our staff and our teams really need to understand why they are there and to get joy from their work in the setting of massive disruption,” she said.
The healthcare sector is experiencing the “post pandemic hangover,” said Anil Keswani, MD, corporate senior vice president and CMO for ambulatory and accountable care at San Diego-based Scripps Health.
“Over the last few years, our minds were focused on the waves of COVID-19. We focused on new treatments, changing guidance, and the repeated surges that we faced. COVID still exists but we are in a new phase of this health crisis that we think of as the post pandemic hangover. Many of us are experiencing the after effects of what happened over the last few years—financial challenges, deferred care that is driving additional demand, patients with long COVID, workplace fatigue, labor shortages, and clinician burnout. This is all built upon increasing costs. The unanswered question is how long this hangover will last and if there is a cure for this hangover,” he said.
2. Medical errors and transparency
Breen said the recent criminally negligent homicide and gross neglect of an impaired adult conviction of RaDonda Vaught, a former nurse who made a fatal medication error at Vanderbilt University Medical Center in Nashville, has impacted how healthcare providers address medical errors.
“After the nurse in Tennessee was convicted criminally of a medical error, it is chilling for all of us. In New York, which can be a litigious environment—we have always talked about protecting the record and protecting our staff. Now, it takes on a whole other view. We not only have to educate our staff but also build quality and peer review systems that are better protected. We need to go into our departments and talk about quality assurance. Then, you have to get the staff to disclose errors—they happen every day. Staff may be worried that anything they say could affect their job, their license, and even bring criminal charges,” she said.
3. Workforce vitality
Efforts to promote workforce well-being and engagement generated vigorous discussions at the CMO Exchange.
“We are facing multiple challenges in the hospital setting presently. For example, we have many patients coming to the emergency department requiring hospitalization but are challenged by staffing shortages. On top of that, we have seen a sharp increase in workplace violence. The staff need support and do not like it when they are on an island dealing with these challenges on their own. They want to see leadership—they want to see you on the floor commiserating, collaborating, and listening. You need to be visible to the staff and to offer solutions. Staff have options today. If they don’t feel supported, they will leave, be it locum tenens or otherwise. We have worked to have leadership on the frontlines, and it has made a difference,” said Erik Summers, MD, CMO and vice chair of internal medicine at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.
Mount Sinai is encouraging leaders to return to face-to-face interactions with staff rather than virtual engagement, Breen said.
“We have been intentional in re-wiring the human component whether it’s on formal leadership rounds or what I call my walkabouts—I walk the units and whenever I do that I run into people and talk with them about what is going on. The leadership team has made a commitment to go around to every unit to thank them for their work. It has become a structured, weekly effort, where we go in and visit one or two units. They know we are coming—it is not a surprise. We take note of what the staff’s issues are and have a structured way of going back to the unit within a few weeks to tell them what we have done and what we cannot do. This process has been helpful, and the follow-up is important,” she said.
Rounding is important, but it is just a modest piece of employee engagement, said Richard Morel, MD, CMO of Optum Tri-State, which employs healthcare providers in Connecticut, New Jersey, and New York.
“I heard a term recently, it is not The Great Resignation—it is The Great Upgrade. Staff is feeling more mobile, and they are looking to improve their situation. We hear it all the time—a competitor group has offered $10,000 signing bonuses for ultrasound techs. There are three things you need to compete on because you want to be The Great Upgrade. First is what staff get for doing their work—their income, their benefits, and their work-life balance. Second is the staff’s purpose at work. In healthcare, this is a relatively easy factor because there is a high purpose in work, but you have to continually promote that in the organization. Third is who is the boss. People will quit over bosses. You have to look at your management team and leadership structure,” he said.
4. Workplace violence
Health systems and hospitals have to work closely with law enforcement to address workplace violence, said Peter Arnold, MD, PhD, associate CMO of hospital operations at University of Mississippi Medical Center in Jackson, Mississippi.
“I have always been an advocate that if someone hits one of my nurses, I would seek to have charges brough against the perpetrator. If somebody says, ‘I am going to come back and shoot the place up,’ and they come back and shoot the place up, I would argue that in addition to the front line providers, the administration is at high risk. I advocate to have law enforcement involved under those circumstances to attempt to de-escalate the situation,” he said.
Reducing workplace violence requires a multipronged approach, Breen said. “There are multiple layers to addressing workplace violence. There is no single solution. You have to layer your response. For example, you have to have de-escalation techniques, good administrative policies, and a low threshold for taking a threat seriously.”
Health systems and hospitals need to be willing and ready to confront patients about workplace violence, Summers said.
“In the inpatient setting, we have developed a process. If a patient can make their medical decisions and engages in verbal or physical abuse with staff, we will go to the floor and talk with the staff to make sure they are OK. Then we talk to the patient to let them know that behavior was not acceptable. We let them know that a behavior contract may be required if their behavior does not change. And, if necessary, we discuss removing the patient from the hospital. While a patient would need to be medically stable to remove, it is imperative to support our staff and keep them safe just as we keep our patients safe. Any patient who engages in workplace violence gets a behavior alert in the electronic medical record, so when they come in again, our staff is aware and prepared for any concerning behavior,” he said.
Christopher Cheney is the senior clinical care editor at HealthLeaders.