Medical Staff Leadership Research Articles

Evolution of the Chief Medical Officer Role in Teaching Hospitals and Health Systems.

Clinical physician leaders have become an increasingly important asset to hospitals and hospital systems in a changing healthcare environment. Specifically, the role of the chief medical officer (CMO) has expanded and evolved amid the shift to value-based payment models and sharpened focus on patient safety, quality, community engagement, and equity in healthcare, as well as a global pandemic. In light of these changes, this study examined the transformation of CMOs and similar roles and evaluated the current needs, challenges, and responsibilities of clinical leaders today. The primary data source used in this analysis was a survey fielded to 391 clinical leaders in 290 Association of American Medical Colleges-member hospitals and health systems in 2020. In addition, this study compared responses to the 2020 survey with findings from two prior iterations of the survey from 2005 and 2016. The surveys collected information regarding demographics, compensation, administrative titles, qualifications for the position, and the scope of the role, among other questions. All surveys consisted of multiple-choice, free response, and rating questions. The analysis was conducted using frequency counts and percentage distributions. Thirty percent of eligible clinical leaders responded to the 2020 survey. Twenty-six percent of the clinical leader respondents identified as female. Ninety-one percent of the CMOs were members of the senior management team in their hospital or health system. CMOs reported that they were responsible for five hospitals, on average, with 67% indicating they were responsible for more than 500 physicians. This analysis provides hospital and health systems with insight into the expanding scope and complexity of CMOs as they take on greater leadership responsibilities within their institutions amidst a shifting healthcare landscape. In reflecting on our results, hospital leaders can understand the current needs, barriers, and responsibilities of today's clinical leaders.

Drug Shortage and Critical Medication Inventory Management at a Children's Hospital During the COVID-19 Pandemic.

Drug shortages have significantly affected the ability to provide care at pediatric institutions, particularly in the inpatient and critical care settings. The coronavirus disease 2019 (COVID-19) pandemic highlighted additional challenges with drug supply chains. A working group consisting of pharmacy management, clinical pharmacists, and pharmacy buyers met regularly at the beginning of the COVID-19 pandemic. In collaboration with medical staff leadership and the Pharmacy and Therapeutics Committee, we developed a pediatric critical drug list to track essential medications for targeted monitoring. We created an inventory model with easily modifiable input variables related to patient and hospital data. This model was aligned across affiliate health care systems to increase transparency of our hospital's surge capacity for managing patients with COVID-19. Here, we share our framework for modeling drug inventory management at a freestanding children's hospital during a global pandemic.

Impact of a Physician Clinical Support Supervisor in Supporting Patients and Families, Staff, and the Health-Care System During the COVID-19 Pandemic.

As coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV2), became a pandemic, hospitals activated Hospital Incident Command Systems (HICS). At our institution, we included a role of Physician Clinical Support Supervisor (PCSS) in the HICS structure. The PCSS role was filled by physicians who served hospital leadership positions, such as Physician Advisor, Medical Staff leadership, Chief Quality Officer, and Chief Medical Informatics Officer. In an effort to summarize the lessons learned by implementation of the PCSS role during the COVID-19 pandemic, we evaluated a PCSS working Microsoft Teams™ spreadsheet and the experience of physicians in the PCSS role. Through efficient daily 2-way communication between frontline providers, HICS, and hospital leadership, the PCSS role facilitated rapid change and improved support for frontline staff, patients and families, and the health-care system. We recommend including the role of PCSS in HICS structure in the event of future pandemics or other crises.

Factors to consider in the introduction of huddles on clinical wards: perceptions of staff on the SAFE programme.

To explore paediatric hospital staff members' perceptions of the emerging benefits and challenges of the huddle, a new safety improvement initiative, as well as the barriers and facilitators to its implementation. A qualitative study was conducted using semi-structured interviews to explore staff perspectives and experiences. Situation Awareness For Everyone (SAFE), a safety improvement programme, was implemented on a sample of National Health Service (NHS) paediatric wards from September 2014 to June 2016. Previously untested in England, the huddle was a central component of the programme. Semi-structured interviews were conducted with 76 staff members on four wards ~4 months after the start of the programme. A thematic analysis showed that staff perceived the huddle as helping to increase their awareness of important issues, improve communication, facilitate teamwork, and encourage a culture of increased efficiency, anticipation and planning on the ward. Challenges of the huddle included added pressure on staff time and workload, and the potential for junior nurses to be excluded from involvement, thus perhaps inadvertently reinforcing medical hierarchies. Staff also identified several barriers and facilitators to the huddle process, including the importance of senior nursing and medical staff leadership and managing staff time and capacity issues. The findings point towards the potential efficacy of the huddle as a way of improving hospital staff members' working environments and clinical practice, with important implications for other sites seeking to implement such safety improvement initiatives.

ANTIBIOTIC STEWARDSHIP IN LONG-TERM CARE: RESULTS FROM AN IMPLEMENTATION STUDY

Due to growing concern that unnecessary overuse of antibiotics in nursing homes (NHs) fosters the emergence and dissemination of antibiotic-resistant bacteria, U.S. NHs are being encouraged to establish antibiotic stewardship programs. Unfortunately, successful implementation of such programs is not straightforward, because decision-making involves a complex interplay of factors. Having demonstrated in a clinical trial that antibiotic prescribing can be reduced by over 25% through comprehensive antibiotic stewardship efforts, our research team implemented a dissemination research study in 28 typical community-based NHs to determine change in prescribing and the factors most critical to success in antibiotic stewardship. After one year of implementation, antibiotic prescribing decreased from 12.39 to 10.95 prescriptions/resident day, with most decrease evident for presumed urinary and respiratory tract infections. The session will also discuss the role of nursing home administration, medical staff leadership, staff and provider attitudes, and intervention activities in achieving and maintaining changes in antibiotic prescribing.

Core Privileging and Credentialing: Hospitals' Approach to Gynecologic Surgery

Study ObjectivePrivileging and credentialing requirements are determined by medical staff leadership at the hospital level to ensure clinicians provide safe healthcare services. No standardized guidelines exist for gynecologic surgery. The objective of this study is to examine the variability of the criteria used to grant surgical privileges and credentials for gynecologic procedures at 5 high-volume academic and community-based US hospitals. DesignWe conducted a cross-sectional study (Canadian Task Force classification III). SettingData was obtained from obtained from 5 geographically diverse hospital systems. InterventionWe examined criteria for designating core gynecologic privileges, credentialing, and other training requirements as well as minimum and annual case numbers for initial granting and maintenance of surgical privileges. Measurements and Main ResultsMajor inconsistencies in privileging were found across the 5 institutions. Hospitals varied widely in procedures designated as core versus those requiring advanced training. Institutions greatly contrasted in the case numbers and temporal factors used to define experience. Of particular concern was absent privileging criteria for 38.4% to 76.9% of minor procedures, 26.7% to 46.7% of endoscopic procedures, and 6.67% to 56.7% of major procedures. Initial and maintenance privileging requirements for special procedures (i.e., robotic-assisted surgery) were likewise discrepant, with minimum annual case numbers ranging from 3 to 48 across hospitals. ConclusionConsiderable variability exists in the criteria used by hospitals for granting and maintaining surgical privileges for gynecologic procedures. Standardization will likely require efforts at a national leadership level.

Hand hygiene compliance: the elephant in the room

Hand hygiene compliance rates for medical staff are consistently lower than those for nurses. Strong leadership to improve compliance has been repeatedly called for, but studies exploring medical staff leadership influence are limited. The qualitative study reported here aimed to explore the perceptions that medical staff have of their clinical leaders and the extent to which they influence hand hygiene practice in their clinical units, and to compare this with unit specific compliance data. Thirty junior doctors from a major tertiary hospital were interviewed or surveyed to uncover their perceptions of clinical leadership and its influence on hand hygiene behaviours. Compliance data for their clinical areas for the corresponding period was obtained and compared with their views on the influence of leadership on hand hygiene behaviour. Consultants, rather than infection control nurses, were seen to have the most influence over medical hand hygiene practices. The unit that scored the best on compliance was also the one where the consultant was perceived to have the most influence. Junior medical staff know that hand hygiene is important but the extent to which they comply with it depends on the influence of the consultant. Infection control staff need to engage consultants in order to improve medical compliance rates, rather than directing their efforts to medical staff in general.

Hospital Case Management and the Utilization Review Committee

This article describes the overall regulatory mandate governing the Utilization Review Committee (URC) in the hospital setting. General structure, function, and meeting format of the URC are important considerations. Furthermore, the URC can serve as a vital platform for medical staff leadership and case management practice to use pertinent risk-adjusted data to drive needed change at the organizational, departmental, service line, and physician level. A case history illustrates the importance of these issues. Acute care hospitals. Case management staff, medical advisors, and physician leaders play important roles in driving changes. The URC will become ever-more important in the rapidly accelerating changes, driving heightened accountability on the part of hospitals.

Derision is the Sweet Spot of Adoption: Unleashing Disruptive Growth

Energetic and ambitious clinicians frequently present new disruptive technologies and growth opportunities to hospital management. Far too often, established medical staff leadership respond to these replacement services with derision, as they sense that the value of their hard-fought experience is threatened. In this regard, derision is often disguised validation and may be the first indicator that the visionary physician is on to something. Truly disruptive service offerings cannot survive the scrutiny of layered medical staff structure or traditional fiscal review. Innovative hospital CEOs should take notice when a new idea is treated with derision and consider resourcing them through an alternative pathway.

Antimicrobial stewardship for inpatient facilities

Antibiotic stewardship aims to improve patient care and reduce unwanted consequences of antimicrobial overuse or misuse, including lowered efficacy, emergence of antimicrobial resistance, development of secondary infections, adverse drug reactions, increased length of hospital stay, and additional healthcare costs. Recent guidelines make specific recommendations for the development of institutional programs to enhance antimicrobial stewardship. Optimally, such programs should be comprehensive, multidisciplinary, supported by hospital and medical staff leadership, and should employ evidence-based strategies that best fit local needs and resources. An infectious diseases physician and clinical pharmacist with infectious diseases training are recommended as core members of the multidisciplinary team, although a hospitalist with interest (and perhaps additional training) in antimicrobial therapy may be able to fill the void. Program directors and core members should be compensated for their time. Principal proactive strategies--with evidence supporting their consideration--include prospective audits, with intervention and feedback, formulary restriction, and preauthorization. Other strategies include persistent one-on-one education, guidelines adapted to local needs, and informatics to support clinical decision making. Intervention goals are to prevent unnecessary antimicrobial starts, to streamline or de-escalate therapy early in its course, and to convert from parenteral to oral therapy, optimize dosing, and ensure the appropriate length of therapy. Most community hospitals, if sufficiently resourced, should be able to implement a successful antimicrobial stewardship program. Evidence suggests that good antimicrobial stewardship can lead to less overall and inappropriate antimicrobial use, lower drug-related costs, reductions in Clostridium difficile-associated disease, and, in some studies, less emergence of antimicrobial resistance.

Hurricane Katrina: More Lessons Learned

In August of 2007, the author testified as the medical expert witness on behalf of the State of Louisiana in the St. Rita's Nursing Home criminal case. Thirty-five residents drowned as floodwaters swept over the nursing home during Hurricane Katrina. For nursing home owners, administrators, and medical staff leadership, there are additional lessons to be learned from this catastrophe.

Responsibility for Quality Improvement and Patient Safety: Hospital Board and Medical Staff Leadership Challenges

Concern about the quality and safety of health care persists, 10 years after the 1999 Institute of Medicine report To Err is Human. Despite growing awareness of quality and safety risks, and significant efforts to improve, progress is difficult to measure. Hospital leaders, including boards and medical staffs, are accountable to improve care, yet they often address this duty independently. Shared responsibility for quality and patient safety improvement presents unique challenges and unprecedented opportunities for boards and medical staffs. To capitalize on the pressure to improve, both groups may benefit from a better understanding of their synergistic potential. Boards should be educated about the quality of care provided in their institutions and about the challenges of valid measurement and accurate reporting. Boards strengthen their quality oversight capacity by recruiting physicians for vacant board seats. Medical staff members strengthen their role as hospital leaders when they understand the unique duties of the governing board. A quality improvement strategy rooted in synergistic efforts by the board and the medical staff may offer the greatest potential for safer care. Such a mutually advantageous approach requires a clear appreciation of roles and responsibilities and respect for differences. In this article, we review these responsibilities, describe opportunities for boards and medical staffs to collaborate as leaders, and offer recommendations for how boards and medical staff members can address the challenges of shared responsibility for quality of care.

From Boardroom to Bedside: How to Define and Measure Hospital Quality

Following the release of its strategic plan, in which patient safety and quality were highlighted as key directions, St. Joseph's Healthcare Hamilton recognized the importance of engaging its board of trustees to achieve these goals. Following a collaborative retreat with senior management, medical staff leadership and professional practice leaders, the board enhanced its governance oversight on quality. By removing quality from the consent agenda, defining quality and selecting a series of "big dot" measures, the board has led the development of a culture of quality that cascades from the boardroom to the bedside. This article describes how the organization followed a systematic process to define quality and select big dot quality indicators.

Improving Pediatric Cardiac Surgical Care in Developing Countries: Matching Resources to Needs

This article reviews a systematic approach to the design and support of pediatric cardiac surgery programs in the developing world with the guidance and strategies of Children's HeartLink, an experienced non-government organization for more than 40 years. An algorithm with criteria for the selection of a partner site is outlined. A comprehensive education strategy from the physician to the allied health care provider is the mainstay for successful program development. In a partner program, the road to successful advancement and change depends on many factors, such as government support, hospital administration support, medical staff leadership, and a committed and motivated faculty with requisite skills, incentives, and resources. In addition to these factors, it is essential that the development effort includes considerations of environment (eg, governmental support, regulatory environment, and social structure) and health system (elements related to affordability, access, and awareness of care) that impact success. Partner programs should be willing to initiate a clinical database with the intent to analyze and critique their results to optimize quality assurance and improve outcomes.

Engaging Physician Leaders in Performance Measurement and Quality

As part of its 2007 Innovation Series, the Institute for Healthcare Improvement released a white paper, Engaging Physicians in a Shared Quality Agenda, in which it described the importance of medical staff leadership and the participation of these leaders in achieving a patient safety and quality culture. Following the release of its strategic plan to 2012, in which it highlighted patient safety and quality as key directions, St. Joseph's Healthcare Hamilton recognized the importance of engaging its medical staff to achieve these goals. To facilitate engagement, a medical quality scorecard was developed in collaboration with medical leaders with a view to enabling physicians to easily identify their program goals, measure their progress and transfer knowledge across the organization.

Patient Safety Rounds: Description of an Inexpensive but Important Strategy to Improve the Safety Culture

Patient safety rounds (PSRs) were established at the University of Michigan Medical Center to improve patient safety by opening a new line of communication between the chief of staff and frontline caregivers. Patient safety rounds are biweekly, hour long meetings between the chief of staff and care givers on individual patient care units. In the past 4 years (2002 to 2006), 70 PSRs have been conducted, and more than 900 area staff members have participated. Staff attendance averages 8 to 10 unit or area staff members per session. Patient safety rounds have proven to be a concrete, inexpensive mechanism to enhance patient safety. Benefits have been documented in the improvement in the safety culture and development and implementation of preventive strategies to solve patient safety issues. Key components in the success of PSRs are active medical staff leadership and the engagement of physicians and senior management in the process improvements the PSRs have directed.

1999 Medical Quality Management Sourcebook

Medical Writings: Book Notes6 July 19991999 Medical Quality Management SourcebookWilliam W. Frailey Jr., MDWilliam W. Frailey Jr., MDLehigh Valley Hospital, Allentown, Pennsylvania. (Frailey)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-131-1-199907060-00035 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Fifth edition. Coughlin K; ed. 598 pages. New York: Faulkner & Gray; 1998. $325.00. ISBN 1579870872. Order phone 800-535-8403.Field of medicine: Medical quality management.Format: Softcover book.Audience: Physician executives responsible for compliance with internal organizational and external oversight requirements in quality management and clinical performance improvement; medical staff leadership and medical directors of hospitals and care management organizations; and physicians who wish to better understand processes to improve clinical performance.Purpose: To provide a practical guide to understanding and responding to the measurement, reporting, and use of data to improve medical care and meet external review requirements.Content: ... Author, Article, and Disclosure InformationAffiliations: Lehigh Valley Hospital, Allentown, Pennsylvania. (Frailey) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 6 July 1999Volume 131, Issue 1Page: 79-80KeywordsComputer softwareHealth careHealth care providersHealth care quality assessmentHealth information technologyInformation technologyMedical staffMotivationPatientsPrevention, policy, and public health ePublished: 15 August 2000 Issue Published: 6 July 1999 Copyright & PermissionsCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

The role of clinical pathways in reducing the economic burden of stroke.

Clinical pathways are a potentially beneficial, but largely untested, management strategy for both improving healthcare efficiency and decreasing costs while also maintaining or improving quality of care. Although relatively few clinical pathways for stroke have been described in the medical literature and although the reported benefits have been mixed, more and more hospitals are adopting clinical pathways as a management strategy for patients with stroke. In published clinical pathways for acute stroke, the following benefits have been reported: (i) reduced use of expensive diagnostic studies; (ii) fewer complications (particularly the frequency of urinary tract infections and aspiration pneumonia); (iii) reduced duration of hospital stay; (iv) reduced patient charges; and (v) lower mortality. However, these reported benefits are not consistent across all studies and some outcomes are highly correlated. Despite potential benefits, many clinical pathway programmes fail because of inadequate planning and shortcomings of implementation. Effective implementation of clinical pathways requires strong administrative and medical staff leadership, active participation of all clinical disciplines involved in the care of patients on the pathway, provision of regular feedback to clinicians, sufficient resources, improved documentation, incorporation of the entire episode of care into the pathway, integration with ongoing quality and utilisation management programmes, and periodic evaluation and modification.

Medical staff leadership: a national panel survey.

Dramatic change in health care has challenged traditional medical staff governance and leadership. The role of medical staff leaders, particularly the chief of staff, and of the medical executive committee is explored through a national panel survey.