The Exec: How to Successfully Lead a Large Medical Group

Strong medical groups function as a network, with clinicians knowing and talking with each other.

Leading a large medical group requires careful listening, understanding the issues, and achieving alignment on key priorities, says RWJBarnabas Health's Andy Anderson.

Anderson has been executive vice president, chief medical officer, and chief quality officer of the West Orange, New Jersey-based health system since May 2022. He previously served as president and CEO of the Combined Medical Group of RWJBarnabas Health and Rutgers Health. Prior to joining RWJBarnabas, Anderson served as executive vice president and system chief medical officer of Aurora Health Care in Wisconsin.

Anderson recently talked with HealthLeaders about a range of issues, including the challenges of leading clinical care at RWJBarnabas, the keys to generating a positive patient experience, and the primary elements of physician engagement. The following transcript of that conversation has been edited for brevity and clarity.

HealthLeaders: What are the primary challenges of serving as CMO of RWJBarnabas?

Andy Anderson: The opportunity is to truly build an integrated health system, and our health system is interested in being one system and one family. Having all of our individual pieces and parts come together for a seamless experience for our patients while we are serving our communities and having our communities become healthier is key.

The challenge is having a common vision and mission as well as achieving good outcomes together. The biggest levers we are pulling  are having system incentives and having everyone rally around the most important things:  the patient experience and quality outcomes. If everyone is centered on those important things, we will be able to come together as an integrated health system.

HL: How are you rising to the challenge of being a fully integrated organization?

Anderson: There are three important levers. One is making sure that we have the right culture. We need a culture where people can speak up for safety, people are working well together on teams, and people are working on continuous quality improvement. The second lever is having strong leaders who are engaged and accountable, with engaged team members who are working together to achieve the best outcomes. The third piece is transparency of data. We need to make sure people know how they are doing. We need to make sure people know how the health system is doing and whether we are making progress on key initiatives. It helps create positive energy when you are making progress.

Andy Anderson, MD, MBA, executive vice president, chief medical officer, and chief quality officer of RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.

HL: What are the primary challenges of serving as chief quality officer of RWJBarnabas?

Anderson: Part of that challenge is making sure there is focus because there are a lot of different areas that can be worked on at once. If you do not focus on the most important areas, then it is hard to move things forward. We have picked some areas where we know we have opportunities to improve based on the data such as prevention of hospital-acquired infections.

So, having focus, clear priorities, goals, and incentivizing everyone around those goals creates alignment, where the whole health system is moving forward together to improve outcomes.

HL: You served as president and CEO of the Combined Medical Group of RWJBarnabas Health and Rutgers Health. What are the keys to success in leading a large medical group?

Anderson: Leading a large medical group requires careful listening and an understanding of what the issues are; then you need to achieve alignment on key priorities. In the work we are doing on patient experience and quality, having clear direction on the key outcomes that we are trying to achieve is crucial. You need to create the vision of where we want to go, set common outcomes such as having a great patient experience and making sure care is coordinated, and make sure that you have created an integrated network within the medical group.

One of the most powerful motivators for a medical group is to have your clinicians be interconnected, know each other, and trust each other. You need a network that is centered around the patients. A high-functioning medical group is going to be tightly interconnected, and it is going to coordinate and integrate care for patients.

HL: How do you establish a network within a medical group?

Anderson: Some of that is people truly getting to know each other, seeing each other, and talking to each other. Clinicians need to have a comfort level to pick up the phone and call a colleague. It also goes back to the common outcomes that we are all trying to achieve together—great patient experience and great quality outcomes. Having everyone centered on those common outcomes brings everyone together. Having a network of positive and trusting relationships is critical. You must foster that and make sure that people are comfortable talking with each other.

HL: What are the primary elements of physician engagement?

Anderson: Physicians are very interested in being leaders. Allowing them to take on leadership roles, then coaching and developing them is very engaging. You need to create career paths for physicians to take on roles, whether it is leading a committee or an initiative, or moving up into an administrative role.

The other important part of physician engagement is two-way communication. You need to make sure physicians understand the priorities of the health system, then listen to them. You want good feedback, and you want to understand the issues at the front line. Sometimes, it comes down to an individual practice and the pain points in that practice, and how you can help solve those pain points. Effective two-way communication is very engaging for physicians as well as the knowledge of the health system, what the priorities of the health system are, and how the physicians can contribute to those priorities.

HL: What are the keys to generating a positive patient experience?

Anderson: Listening to the patients very purposefully and understanding what their priorities are is important. We need to listen to any issues that they may identify while they are in our hospitals or other facilities. Then you need to close the loop. If there is an issue that we hear about with an individual patient, we need to close the loop on that issue right away—it makes a big difference for that individual.

I was rounding recently, and we had a patient who was not sure who their doctor was going to be because their current doctor was retiring. After rounds, we talked immediately with the care team, who went back to the patient and helped the patient understand the transition to a new doctor.

So, closing the loop with an individual patient makes an enormous difference for that person. More broadly, we need to understand what the themes are by listening to patients. We need to find out if there are themes emerging about the environment, the food, how much patients know about their day in terms of procedures or tests they are going to have, and whether their doctor and nurses are communicating appropriately. Just getting that information by listening to our patients is impactful to improve the patient experience.

In addition, employee engagement is the underlying way you can improve the patient experience. If your employees are excited to be at work, they are happy to be at work, and they are centered on mission and purpose, then they are going to deliver the best possible care to our patients. So, focusing on our employees is a critical part of being successful with our patient experience.

HL: What is the role of clinicians in organizational administration at RWJBarnabas?

Anderson: It is very important to have the voices of physicians, nurses, and other clinicians—those who are doing the work and delivering the care. It is much better when there is communication, understanding, and coordination with those clinicians. To have a health system that is truly effective and efficient, that clinician voice is critical.

We have purposefully engaged our nurse leaders and our physician leaders. They typically co-lead our quality, safety, and patient satisfaction projects with dyad nurse leadership and physician leadership driving initiatives. It is powerful and great role-modelling.

Part of how we have organized ourselves is through service lines such as cancer, neurology, cardiovascular, and pediatrics. The model for those service lines is to have a dyad leadership team with an administrator and a clinician. Having a clinician be a co-leader of a service line is one of the examples of how we have clinicians involved in administrative leadership.

Another example is that each of our hospitals has a chief medical officer and a chief nursing officer. They are very much at the table and often leading initiatives, particularly quality, safety, and patient satisfaction. They are the leaders for those initiatives and make sure that we are making progress.

Related: The Exec: Transparent Leadership Crucial Element in Physician Engagement