Is Unprofessional Conduct Poisoning Your Care Teams and Clinician-Patient Relationships?

Senior leaders such as CMOs need to model professional behavior, Smith explains.

“Senior leaders should not just tell people what to do, they should show people what to do in their own behavior,” Smith says. “If there is an assistant CMO who is not signing their charts but is telling clinicians they need to sign their charts, that is not going to fly.”

To promote professional behavior, Smith says a CMO and other senior leaders should strive to create a workplace environment that has psychological safety, so staff members can report unprofessional behavior without fear of retaliation.

At most health systems, hospitals, and medical groups, expectations for professional behavior are part of employment contracts.

“There are policies for how staff members should treat their colleagues and patients,” Smith says. “A CMO and other senior leaders should ensure that these contractual obligations and policies are well known, and they should revisit them with staff on a frequent basis.”

When unprofessional behavior by a clinical staff member is reported, Smith says a CMO must have a process in place to address unprofessional conduct that includes documentation of incidents.

While the response to relatively minor incidents of unprofessional conduct such as disrespectful interactions may only require a face-to-face conversation between a CMO and a clinical staff member, major incidents require an uncompromising response, according to Smith.

“For serious incidents of unprofessional behavior such as physical assaults and sexual harassment, you should have senior leaders such as the CEO, CMO, and medical staff leadership involved in the process,” Smith says. “These kinds of incidents should not be tolerated and can result in termination.”

Keys to success in risk stratification of patients

For CMOs at health systems, hospitals, and medical groups, risk stratification of patients is an important element of managing a patient population, Smith explains.

“You need clean and reliable data about the patient population such as acuity of illness,” Smith says. “You conduct risk stratification of patients so that you can apply resources to patients who are sicker because they require more care.”

Smith says risk stratification also generates opportunities to improve patient safety and quality of care.

For example, risk stratification can identify heart failure patients who are on multiple medications, and it can be helpful to have a pharmacist review the medications to ensure there are no adverse interactions, Smith says.

There are several ways to collect data to conduct risk stratification of patients, including harnessing data in the electronic health record, according to Smith.

“The EHR gives you data including patient history and patient conditions such as diabetes and hypertension,” Smith says. “This data informs the utilization of medical services and cost of care for chronic diseases, which require management and treatment.”

Other ways to collect data for risk stratification include patient surveys and pre-visit assessments, Smith says.

Effective hospitalist medicine teams

There are several elements that drive effective hospitalist medicine teams, according to Smith, who served as interim medical director of hospitalist medicine at Henry Ford Allegiance Health.

For example, hospitalist medicine teams coordinate consultants who give opinions about care such as cardiologists for heart failure patients and nephrologists for renal failure patients. But ultimately, the hospitalist team guides the care of patients, Smith says.

To play a care coordination role, it’s also important for hospitalist medicine teams to be integrated with the rest of a hospital’s medical staff, according to Smith.

“Like emergency medicine clinicians, hospitalists have a jack-of-all-trades mentality, and they manage many angles of a patient’s care, but they need to be integrated with the rest of the medical staff to provide comprehensive care,” Smith says.

Hospitalist teams need administrative support to handle some aspects of a patient’s care such as case management and prior authorizations, Smith explains.

If there are multiple hospitalist teams in a hospital, the CMO should try to reduce variability in how they provide care to promote the highest possible quality of care and to ensure that patients are getting in and out of the hospital on a timely basis, according to Smith.

“A CMO needs to play the role of facilitator, including making sure that hospitalist teams understand the value and the ‘why’ behind reducing variability in care,” Smith says. “A CMO should meet with hospitalist team leaders and explain that variability in care can have a negative impact on performance such as causing delays in care and increasing costs.”