The Exec: What It Takes to Be an Effective Physician Leader

By Christopher Cheney

Physician leaders should have fundamental knowledge of all aspects of healthcare, says the chief physician executive of the Mercy health system.

Jeffrey Ciaramita, MD, is senior vice president and chief physician executive at Mercy. A practicing cardiologist, he previously served in leadership roles at Mercy Clinic, a large medical group affiliated with Mercy.

Ciaramita recently talked with HealthLeaders about a range of issues, including physician leadership, workforce shortages, and patient safety. The following transcript of that conversation has been edited for brevity and clarity.

HealthLeaders: What are the main elements of physician leadership?

Jeffrey Ciaramita: Most people believe physician leadership is representing physicians. That would be a big mistake. Physician leadership is digging into the details and being a healthcare executive with fundamental knowledge of all foundational aspects of healthcare, including operational, strategic, service line, workforce dynamics, and financial.

Physician leadership is having a foundational understanding and using that foundation to inspire excellence in others, which includes other physicians and advanced practice providers. You need to inspire excellence, then lead change. Everyone inside and outside of healthcare knows that healthcare has evolved and changed over the years; and as we saw over the past couple of years, it will continue to change. The only way we are successful as physician leaders—whether it is a chief physician executive title or any other title—is if we can navigate and lead our teams through change.

HL: What is the status of physician burnout at Mercy?

Ciaramita: Luckily for us, Mercy partnered with the American Medical Association. We partnered with them to create a longitudinal study for physician burnout. As we were navigating the creation of this study and longitudinal surveys, COVID was just starting to hit.

Our initial AMA survey results showed us that we have a moderate amount of burnout in our ministry. It also showed us that we have a lesser degree of burnout within Mercy than the national averages. That being said, overall for physicians and staff if we look at burnout, there is no question it has probably been at one of the higher levels throughout most people’s careers.

We have gone through our second round in the longitudinal study and are awaiting those results. My suspicion based on early indicators is that we are improving. There is a feeling among our staff that there is a light at the end of the tunnel.

HL: What are the primary initiatives you have in place to address physician burnout?

Ciaramita: We have a Rapha program that has an app associated with it. Rapha comes from the Hebrew word “to heal.” That is a confidential program, where physicians can mentor and be resources to other physicians who have self-identified themselves as struggling. They want to connect and discuss issues. We have had this program in place for a few years.

Last year, Mercy adopted universal usage of Schwartz Rounds. Schwartz Rounds are co-worker events that are in a grand rounds type of style. They either focus on a medical case or a theme related to the emotional impact of patient care. Staff members talk about a case or talk about the theme, and they can navigate their own experiences and feelings with a sense of community. Schwartz Rounds can be 10 people or 100 people.

We have Mercy Mission Teams, which have paired up with new physician wellness leaders to have wellness, mission, and culture committees.

This all is in addition to our employee assistance program, which allows 24/7 access for any employee to professional resources.

HL: What are your primary clinical challenges now that the crisis phase of the coronavirus pandemic has passed?

Ciaramita: The big one is providing the breadth and the quality of clinical care with the highest level of patient satisfaction in the setting of a massive workforce challenge. Finding enough staffing and retaining enough staffing throughout our clinical areas is a challenge.

HL: What kind of workforce shortages are you experiencing at Mercy?

Ciaramita: Our workforce shortages are similar to the trends nationally. Within Mercy, our biggest challenges are in the areas of support services and clinical services. We have shortages in nurses, medical assistants, medical receptionists, imaging technicians, operating room technicians, and other positions.

Most of the shortages are not simply because of wages. Most of the shortages are the result of a workforce that demands flexibility … such as changes to their work schedule.

From our perspective, our number one strategy for workforce shortages is focused on retention. We have many great employees, which are the singular reason for why we are a high-quality ministry, and we have achieved some of the best patient satisfaction in the country. We know that comes from the employees who are with us today.

HL: What are you doing in terms of recruitment and retention?

Ciaramita: We have refined our recruitment process. We have identified areas to improve the onboarding of every employee who works within our ministry. We have shortened the timeline when someone applies for a job. We have made a lot of our recruitment electronic and user-friendly.

We have offered several different types of bonuses such as sign-on bonuses and bonuses for referral of new employees. We are keeping up with the market, and we are making sure that we are valuing employees financially with compensation that is commensurate with our desire to bring in the best of the best. We are also partnering with educational institutions to help build a pipeline of future employees.

We are continuing to refine our work toward automation. This is not automation to eliminate positions. It is automation to augment positions—knowing that as healthcare demands grow as our communities age and the demand for complex care grows, we will likely never have enough human beings to deliver care. We will continue to work on automating tasks, while we are partnering with institutions to build a pipeline of nurses, advanced practice practitioners, medical assistants, operating room technicians, and other healthcare workers.

I cannot stress enough the financial, cultural, quality, and distinct workforce benefits by focusing on retention. We hold town halls—we are assessing how we can meet the needs of our staff.

We have created a gig workforce program. Our gig program is similar to agency or contracted labor. We created our own internal program that provides flexible hours and ease of scheduling. So, for our own nurses, for example, some of whom may work 40 hours a week or some of whom may work 30 hours a week, they can go into our gig program and pick up an additional two hours, or four hours, or 16 hours if they want. They can work in different areas, but they are still Mercy employees. They can work when they want, how they want, and in the setting that they want.

HL: What are the primary elements of patient safety at Mercy?

Ciaramita: We have instilled in our co-workers—our clinicians and every single person who has the honor to touch a patient that we serve—a culture of first and foremost do no harm. If you look at Mercy’s commitment to quality, we have made a commitment in every community that we serve to be the number one high-quality healthcare provider by nationally reported metrics.

We have created a culture of reporting that not only covers lapses in care and errors but also promotes reporting of near misses. In near misses, there was not a safety event but there could have been a safety event. Our co-workers are focused on learning from errors and near misses rather than having a punitive approach. How can we find out what happened? How can we document an incident? How can we bring in a team to do an analysis to make sure that we can broaden our educational opportunities about what happened in every community we serve? This work is reflected in our high quality scores.

We utilize our electronic health record to create alerts to avoid medication errors and vaccine administration errors. We have very robust systems in our EHR to avoid those errors.

I would put our patient safety under the auspices of our dedication to an overall high-quality system. That high-quality system within our ministry all falls under a newly created department called the Office of Clinical Excellence. This department is using evidence-based medicine, technology augmentation, and a humanistic approach to education, culture, and learning to drive patient safety.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.