The Exec: 'I Strongly Believe That All Physicians Are Leaders'

The chief medical officer of Providence Newberg Medical Center says physicians are natural team leaders.

The chief medical officer (CMO) of Providence Newberg Medical Center says her clinical background in internal medicine prepared her for physician leadership by providing insight to giving care at the bedside.

Amy Schmitt, MD, has been CMO of the Newberg, Oregon-based hospital since March 2013. She took on the role of interim CEO in June. The hospital has 40 inpatient beds and 15 emergency department beds.

HealthLeaders spoke with Schmitt recently about a range of issues, including the challenges of serving as CMO of the hospital, balancing the roles of CMO and interim CEO, and lessons learned during the coronavirus pandemic. The following transcript of that conversation has been edited for clarity and brevity.

HealthLeaders: What are the primary challenges of serving as CMO of Providence Newberg Medical Center?

Amy Schmitt: Providence Newberg is a relatively small community hospital. We function at a much higher level than most hospitals our size. We have a relatively small medical staff, but we hold ourselves to the same quality standards and other aspirations of larger hospitals.

With a small medical staff, leadership is always a challenge because we have only a few capable and dedicated individuals who are willing to be leaders and to be tasked with multiple hats. You find someone who is really good, and you ask them to participate in many ways.

Another challenge is also related to our size. We are held to the same quality standards as other hospitals. We want to meet the infection ratios that the Centers for Disease Control and Prevention recommend, but because we don't see the volume of patients that larger hospitals see, many times our threshold for an acceptable infection rate is zero. For example, we may only be allowed 0.4 catheter-associated urinary tract infections, which essentially equates to zero infections. Zero is a difficult standard for us to hold ourselves to, but we do it. There is no margin for error for us in meeting quality standards.

HL: Do you characterize the communities you serve as rural?

Schmitt: We are not technically a rural hospital. We are about 25 miles outside of Portland. However, we have a rural population in that they like being outside of Portland, and they prefer not to go to Portland unless they absolutely have to go. So, we try to do what we can to meet the needs of our community at our hospital. We offer services that other hospitals our size would not typically offer.

HL: In addition to serving as CMO of the hospital, you have been serving as interim CEO. How are you balancing these roles?

Schmitt: It has been interesting. Since becoming interim CEO, I have been dedicating more of my time to the CEO role, which is new to me in many ways. Thankfully, I have been the CMO here for 10 years, so I have that piece down well and we do not have any medical staff upheavals at the moment. I have been able to pull some of my time from the CMO responsibility to take on new tasks.

There is some overlap between the roles. Previously, the CEO and I partnered on many of the contracts and medical staff engagements. Now, instead of the two of us working in those areas, it is just me.

The other piece is having a great team that has been able to fill in the gaps and to help bring me up to speed. We have a great executive team and administrative team as well as great managers in all our departments. They are largely self-sufficient, but they come together when they need support; and when I need support, they are right there to help me.

Amy Schmitt, MD, chief medical officer of Providence Newberg Medical Center. Photo courtesy of Providence health system.

HL: You served as CMO of the medical center during the coronavirus pandemic. What were your primary learnings from this experience?

Schmitt: It took healthcare to a new level of having to become more interdependent on our community. Healthcare used to be more siloed than it is now. We have learned to partner with other health systems and with our county health departments. To promote public health, it caused us to create lines of communication and collaboration that were weak before. We were able to learn best practices from each other, and we figured out how to navigate the pandemic together rather than each of us trying to go through it individually. It was good to see the connections with Oregon Health & Science University and Legacy Health as well as some of the other major healthcare providers in our area.

Another piece was the critical nature of being consistent both in our approach between hospitals and clinics as well as having constant communication about changes. What created more problems than anything was when one hospital may have done something differently and a patient was going back and forth between different health systems and getting mixed messages about the best ways things could be done. Coming together and deciding best practices was crucial.

Things changed rapidly with COVID, so what we said one week could change two or three weeks later based on expert advice or new data. We were constantly going back to our staff and trying to be transparent about what we knew and did not know. We would have to say that as new data comes forward and new studies are completed, we may have to revisit things and change the communication over time. Things that we were doing early in the pandemic changed over time, and it was a very fluid process.

HL: What is the approach to patient safety at the hospital?

Schmitt: We started a journey of high reliability in 2013. That journey started with trying to figure out how we could create an environment where patient safety was at the center of everything we did. When we started, the journey was reactive, and we tried to create psychological safety so that everyone within our walls felt comfortable raising safety concerns—whether you were an environmental services worker, a nurse, a provider, a technician, or other staff member. We wanted everyone to be able to say, "I'm concerned about this process because it may not be safe for our patients." Then, we wanted to be able to react to concerns and put corrective processes and systems solutions in place.

As we have developed our high-reliability efforts over time, we have tried to become more proactive to prevent situations that impact patient safety. Part of that is every decision, every change, and every new workflow is viewed through the patient safety lens.

We still want to have psychological safety, and we want to treat everybody with respect and dignity, so they feel comfortable raising concerns; but at the same time, we want to be proactive in looking at our processes and preventing people from getting into a situation where they have to report and speak up.

One of the ways we track our progress is by how many Datix reports we get. Datix is the system we use for anyone in the hospital to be able to speak up regarding an unusual event or something they feel is out of the ordinary. They can file an electronic report such as near misses or an error that reached a patient. We track those Datix events and categorize them as reaching the patient, causing any injury, or near misses. We want to see a high volume of Datix reports because that means people are comfortable reporting; and when we started our high reliability journey, we saw an increase in Datix reports. The goal over time is to decrease our safety events. Over time, we have seen a dramatic decrease in our serious safety events.

HL: What is the role of physicians in administrative leadership at the hospital?

Schmitt: This is my passion. We have physicians at all levels of leadership. Sometimes, physicians get shuffled around, and as one leaves a role, we pull them into another position because when you have a capable leader, you do not want to lose that expertise.

We have several layers of leadership. We have our department chairs, who work side-by-side with nurse managers in each department to make sure that their department is high functioning, has good quality standards, and they can meet patient care needs. For our medicine department, we have a medicine department chair paired with our med-surg nurse manager for surgical services. We have a surgery department chair. We have an OB/GYN chair. These chairs provide local expertise that is needed to develop processes and to make sure everything they are doing is up to date.

Each of the department chairs serves on our medical executive committee, which governs our medical staff. We nominate a president of the medical staff, who chairs the medical executive committee. Together, that group, with administration in attendance, makes decisions such as whether we have the right composition of our medical staff or whether we need to recruit new physicians or whether there are quality standards we need to rally around as a medical staff. If there are disciplinary actions that need to be taken, the medical executive committee is in charge of that process.

HL: You have a clinical background in internal medicine. How has this clinical background helped prepare you to serve in physician leadership roles such as CMO?

Schmitt: I strongly believe that all physicians are leaders whether they choose to embrace leadership or not. Just by the nature of their training and experience, physicians are natural team leaders whether it is in an office with medical assistants, an operating room with a surgical team, or another setting.

As I have gone through my training and career, I have been willing to embrace leadership. All physicians have opportunities to embrace leadership—it is a matter of who is willing to develop it.

The internal medicine training I received was an opportunity to be at the bedside. I have been a clinical hospitalist since 2005. Even as a CMO, I have maintained that hospitalist work. It gives me the perspective of what it is like at the bedside as well as what our physicians, nurses, and advanced practice providers are facing day in and day out, and how I can ease their way as a leader.

Related: The Exec: Emergency Medicine Great Background for Physician Leadership