I was sitting in a small conference room. Having worked full-time as hospital Chief Medical officer, I was now interviewing for a position in a larger institution. Midway through my interviews, I was talking with the hospital board chairman. He brought up the topic of hospital sentinel events. Apparently there had been a sentinel event at his organization and the chair and his board were quite concerned.
He explained that it was something they had not experienced before. They were upset that such an event could occur at their facility. He asked me to describe what I knew about hospital sentinel events and share some of my experiences.
OK – it’s time for another edition of VITAL Physician Executive’s Monthly Leadership Favorites. In this feature I share inspiring and enlightening advice from respected leaders, generally outside of the healthcare field.
This month’s favorites follow…
This month I am adding 20 blogs to my initial list, to present 50 physician authored blogs. You may recall that I posted my first list of 30 blogs at My Fascination with Physician-Authored Blogs. I’ve added twenty new sites. All 50 of them are included in this updated table. The new ones are listed at the top.
In the updated list, there are several that have more of a commercial bent. That is to say that they have been monetized to some extent.
Probably the ultimate example of this is KevinMD. This one is familiar to many of us. It is one of the longest running. I included a note that the “blogger” is an internal medicine specialist. That’s because it was founded by Kevin Pho, MD, an internist. However, anyone that has read its articles knows that it is actually a news blog that lists articles from hundreds of writers – many of whom are physicians.
For this post, I’m going to “nerd out.” I love using data. And I love monitoring, improving and discussing quality and safety. That was one of the fun things I did as hospital CMO. I also enjoy playing around with ways to display data, especially for lay people with a limited understanding of statistics. So today we will make our way to the “popular” Bubble Graph (well – it’s popular with me at least), as I demonstrate how to prepare quality reports.
The CEO and the Board of Trustees (or Directors) definitely want to see meaningful reports about hospital performance. They truly want to see that performance is improving. Along with positive financial results, nothing will make the CEO and board happier than seeing that quality can be measured, is at an acceptable level, and is improving.
Each hospital CEO must determine which departments should logically report to each senior executive. Historically, the vice president for medical affairs or chief medical officer was hired to address the medical staff and its governance, continuing medical education and quality improvement. But there is another department head that should report to the senior physician executive of a hospital: the hospital pharmacy director.
Medication administration is one of the most important functions of a hospital. Safe, effective and timely administration of medications requires coordination of multiple hospital staff departments, integration of electronic medical records, implementation of pharmacy automation, and monitoring and managing drug costs.
Welcome to my second interview with a successful physician executive and leader. This time, I interview Lawrence Earl, MD. Larry made the transition early in his career from practicing clinician to medical director and then owner/CEO of his own urgent care company.
He later sold his practice to Concentra, a large provider of urgent care and occupational medicine services that is very well-known in the urgent care arena. I know the company because when I was looking to leave my position as hospital CMO, one of the companies that interviewed me was Concentra.
The company was in the process of buying up and integrating urgent care networks. Concentra itself was acquired by Humana in 2010. It was sold by Humana to a private equity fund in 2015.
I was intrigued by Dr. Earl’s story after I became medical director of an urgent care center in 2014. I began hearing about education provided by UrgentCareMentor in 2015. I started to read the blog posts and other free content.
Dr. Earl’s company appeared to be the only online provider of occupational medicine, workers compensation and urgent care education. His material is actionable and more sophisticated than material being provided by some of the urgent care associations.
Then, in 2016, I started this blog and immersed myself in the world of physician bloggers and the technologies and tools used to create and monetize a blog or website. And, trust me, it is no simple feat to create an online presence, especially one that produces regular education and training that physicians are willing to pay for.
One of the things that was nice about being on the executive team of a hospital was the possibility of making a year-end bonus. The bonus was generally tied to achieving four or five organizational goals, but we had a good team and we generally received 70 to 80% of the monies that we were eligible for each year. The bonus was usually paid in March. Including the bonus dollars, my annual executive salary was well above my previous clinical salary.
One of the questions that any physician thinking about a career as a healthcare executive will consider is: How well will I be compensated? It is probably not the most important question. But it can be a concern for a mid-career physician thinking of making the transition. A reduction in income may not be acceptable, even if it is only temporary.
Summa Health System (Physician) CEO Resigns
I recently wrote about the consequences of poor communication. It appears that a breakdown in communication may have led to failure of the Summa Health System to reach a contract with its ED group. The group of over 60 physicians had been with the Akron, Ohio based system for decades.
The second breakdown came when there appeared to be little or no communication by the CEO about the impending change in ED providers with the medical staff and other stakeholders.
Unhappy Medical Staff Leads to CEO Resignation
The resulting chaos and outrage ultimately resulted in a no-confidence vote by a group within the medical staff. The board was apparently under intense pressure to force the resignation of the CEO, Dr. Thomas Malone. Today, his resignation was announced and written about in Crain’s.
I’ve written about why I think physician executives can make excellent hospital CEOs. I don’t know exactly what went wrong in Akron that led to the events leading up to Dr. Malone’s resignation. But it serves as a warning to hospital leaders not to take for granted the strength of their position. Or neglect the need to proactively communicate with all stakeholders when making tough calls.
Every year, the health system pharmacy director and I would sit down and review the latest Institute for Safe Medication Practices (ISMP) list of best practices. These are practices based on reports of medication errors from hospitals across the country. When the ISMP identifies a trend, it seeks the root causes. It then compiles preventive strategies and publishes them as ISMP Best Practices for Hospitals.
I found these best practices to be a good source of goals for the pharmacy director. If there was a recommendation that we had not implemented, the director and I would add it to his goals for the upcoming year. The CMO should be a strong advocate for medication safety.
I was walking towards the cafeteria one morning when I recognized one of our hospital board members. I recalled seeing him at one the meetings where I had presented hospital board reports addressing quality. We stopped to chat for a minute.
He had been on the board for several years, and had an intimate knowledge of the performance of the hospital. He knew many of the local medical staff. His wife had once worked for the hospital.
At one point in our brief conversation he said, “ You know, John, I really look forward to your quality reports. We all do. The board members like to know that things are going well. We also want to know when there are potential problems, and the steps taken to address them.”
I thanked him and promised that I would continue to keep the board informed, and he went on his way. Over the years, other board members mentioned similar sentiments. They were very interested in how the organization was addressing quality and safety.