The Exec: 'I Call Myself the Chief Facilitating Officer'

In improving operational efficiency, the chief medical officer of Duke Regional Hospital makes sure that the medical staff has a voice in the effort.

Adia Ross, MD, MHA, chief medical officer at Duke Regional Hospital, says she relies on the expertise of provider leaders to solve problems.

Ross became CMO of the Durham, North Carolina, hospital in 2020. Previously, she served as medical director of hospital medicine service at Duke Raleigh Hospital and assistant medical officer of quality at Duke University Hospital.

HealthLeaders recently talked with Ross about a range of issues, including challenges of leading clinical care at Duke Regional Hospital, her primary learnings as CMO during the coronavirus pandemic, and advice to other female physicians interested in administrative roles such as CMO. The following transcript of that conversation has been edited for clarity and brevity.

HealthLeaders: What are the primary challenges of serving as CMO of Duke Regional Hospital?

Adia Ross: There are a couple of challenges. One is dealing with provider and clinician burnout, and trying to come up with ways to make sure we can foster community and a sense of well-being in a time when there is a lot of uncertainty. We try to focus on things that are under our control and promote joy. We focus on things that go well and try to celebrate those things. As leaders, we are focusing on things that get in the way of providing good care.

The other challenge is engaging providers in operational efficiency work in a way that honors what they have been doing in the past while trying to push us forward and to be innovative. This work also involves focusing on value, quality, and safety.

I call myself the chief facilitating officer. When we are thinking about operational efficiency and making things better, I want to make sure that the medical staff has a voice in that effort. I have provider leaders designated by specialty, and I rely on them and their expertise to think about how to solve problems. I give them the “what” and rely on them to give me the “how.” I make it clear that as we go through and try to learn and innovate, and be more effective and efficient, that safety and quality must be at the forefront. They can't be compromised.

HL: You became CMO of Duke Regional Hospital during the first year of the pandemic. What have been your primary learnings as CMO during the pandemic?

Ross: I learned a lot about uncertainty and how it can lead to innovation and clarity of purpose. What I mean by that is when you have many things changing daily and you can't operate in the normal way you have operated in the past, it can cause a lot of internal angst. But you can work through that and say, "We may not be able to use our old bag of tricks, but we have the critical thinking skills, and we can figure out how to get through this." Even in the times of uncertainty, you can find clarity of purpose by working together and just putting one foot in front of the other.

Another thing I learned is how to be operationally flexible, while making sure that flexibility is based on sound principles. So, you need to focus on the problems you need to solve, then think about flexible ways to implement solutions.

Focusing on transparent communication is important. In times when things are changing, you want people to have access to you.

Adia Ross, MD, MHA, chief medical officer of Duke Regional Hospital. Photo courtesy of Duke Health.

HL: Now that the crisis phase of the pandemic has passed, what are the top clinical care issues at Duke Regional Hospital?

Ross: We are trying to cultivate a dual mindset of focusing on quality and efficiency. Managing patient flow and length of stay is a challenge for most health systems at this point—those are things we are trying to work on and get better at. It is important for our community to have timely access to care, and we are figuring out how to do that while focusing on quality and safety.

HL: Give examples of a care quality initiative you have been involved in at Duke Regional Hospital.

Ross: As the chief medical officer, my role is as a chief connector and sponsor of work. I see my role as helping to facilitate the work of frontline leaders and leveraging their expertise, so there have been many quality projects that I have been involved in. For example, I have worked with workplace violence initiatives to decrease events occurring with patients who are elderly and demented. We started a behavioral response team, and I helped make sure that we had a staffing model with nurses and providers, and I helped make sure that we had good outcomes and goals.

I sponsored and supported community-based research. We have done a lot of community-based research with COVID and other areas.

I continue to work on length of stay and serve as one of the physician champions helping to bring together hospitalists, specialists, critical care providers, and emergency department providers to work on ensuring that we can get patients in and out in a timely fashion.

HL: What advice would you offer to other female physicians who may be interested in serving in top administrative leadership positions such as CMO?

Ross: There are a lot of women entering the field, but as you go up the ladder, there are fewer and fewer women in leadership positions. When I think about my role and how I have gotten here, I had an understanding of the factors that allow people to accelerate their careers. I talk about developing a career map—where do you want to go? I did have aspirations to be a chief medical officer, so I tried to think about my career in different phases and five-year increments. I tried to think about the things that would be helpful to advance.

It's important to conduct informational interviews. If you see people in positions that you would like to be in, talking to a variety of them and understanding how they got there will help you develop the pathways to get there yourself.

Having mentors who understand what your goals are can help connect you with sponsors or sponsor you for work.

One thing that people underestimate is volunteering for assignments. One of the ways I have gotten to where I am is I always signed up for things that were outside of my comfort zone. If you are a clinical person, you must think about taking assignments that have nothing to do with your area of specialty and try to stretch yourself to gain knowledge of different operational areas than what you are familiar with.

I would just say be courageous.

HL: You provide leadership support for several clinical and operational departments, including medical staff services, pharmacy, nutrition services, emergency medicine, diabetes management, infection prevention, case management, and palliative care. How do you manage to juggle this broad area of responsibility?

Ross: First, I have wonderful leaders who work alongside me. They have clinical and operational expertise, and my role is to make sure they have the resources that they need. If there are barriers that their teams are facing, I work to eliminate those barriers.

It is really about the team that you have because they support you in doing the work.

Related: The Exec: What It Takes to be an Effective Physician Leader