The Exec: New York CMO Lists 3 Critical Components of Clinical Integration

The CMO says clinical integration requires communication, trust, and knowing roles and expectations.

To achieve successful clinical services integration, healthcare leaders can't sit in their offices and wait for things to happen, says Philip Heavner, MD, MBA, chief medical officer of Guthrie Cortland Medical Center.

Heavner became CMO of the medical center in September, having previously served as Guthrie Clinic's system chief of pediatrics. Before joining the five-hospital health system, he was chief of pediatrics at Bassett Healthcare Network.

Heavner recently talked with HealthLeaders about a range of issues critical to the role of the CMO, including ensuring clinician engagement and establishing clinical integration.

Clinical integration success requires communication, trust, and making sure the contributors know their roles and expectations, he says.

"As the CMO of a regional hospital, when you have various clinical services such as the emergency department, inpatient services, surgical services, and a cancer center, you need to make sure that the provision of services is well understood across the organization," he says. "You need to communicate with each other to get things done clearly and safely."

CMOs also need to play an active role in clinical integration.

"You make yourself visible," he says. "You do not sit in your office and wait for things to happen. You reach out to people, and you ask them about what support they need as opposed to being passive. When you ask someone what they need, you need to address it."

When there are inadequate resources to support a clinical integration initiative, healthcare leaders need to be direct and honest, Heavner says.

"You acknowledge that any clinical initiative that makes sense deserves support, but there may be a lack of resources for the initiative," he says. "Our organization has a clear strategic process, where we consider and prioritize the resources that we have. We rely on that expertise to decide how resources are distributed. So, you explain the process for how we make decisions, and you help colleagues understand why we are not able to provide resources based on what our overarching strategy defines for us."

Philip Heavner, MD, MBA, chief medical officer of Guthrie Cortland Medical Center. Photo courtesy of Guthrie Clinic.

Rising to CMO challenges

The biggest challenge for CMOs is balancing the clinical factors that contribute to quality, safety, and patient experience, Heavner says.

"You must manage the expectations of all the stakeholders and be a reliable go-between," he says.

In the current healthcare environment, human resources are a primary consideration for CMOs and other leaders.

The coronavirus pandemic taught healthcare leaders the value of nurses, and their stock has risen as a result, Heavner says. Nurses are in high demand, and there are probably not enough experienced nurses to cover the needs of all the healthcare organizations in the country, he says. To be competitive in recruiting nurses, Guthrie Cortland Medical Center needs to be a place where nurses want to be, he says. "We need to be a destination for their careers."

Beyond nursing, there are human resources challenges in other capacities, Heavner says.

"There are other parts of our team that take care of our hospitals and do the work after hours that most people would not wish to do," he says. "Those folks are in demand, too, and this includes our clinicians—our doctors and advanced practice providers. We are constantly trying to attract and retain the very best clinicians, and that is a challenge right now."

Staff retention is critical for healthcare organizations. "Compensation must be fair," Heavner says.

You must be competitive in your market for clinicians, nurses, and support staff, he says. Healthcare leaders also must be clear about their organization's expectations and standards, he says. They also must make sure staff members feel supported in achieving goals related to patient safety, quality, and patient experience. "It is not just about patient experience—it is about clinician and caregiver experience, too. Those things go hand in hand," Heavner says.

Recruitment starts with a clear vision and a clear message about mission and values, Heavner says.

"It starts at the top with our president and CEO, who is a practicing physician. He talks the talk and walks the walk," he says. "When I sit down with someone who is considering an opportunity here, I tell them that this is a good place to work with a conscience. I tell them we take excellent care of our patients and are involved in our communities. I tell them this is a place where they can build a career."

Effective clinician engagement

Clinician engagement is similar to patient engagement, with a premium on clear communication, transparency, and honesty, Heavner says. But there are other key factors as well to take into consideration.

He says health systems and hospitals need to make sure the electronic medical record is a valuable tool rather than an obstacle to quality care. They need to make sure clinicians have time to continue their medical education, he says. And clinicians need to know that their voices are heard. "When a clinician speaks up and says they need assistance with an issue, it should be addressed," he says.

Guthrie Cortland Medical Center has several clinician engagement strategies, Heavner says.

The medical center conducts safety huddles every day, which promotes clinician engagement. The hospital also conducts multidisciplinary rounds every day, where the clinical care teams review every inpatient, their care plan, and what can be done better. In addition, there are regular medical staff meetings. "I meet with the leadership of the medical staff and departments on a regular basis. We talk about how we are taking care of our staff. If you make engagement a priority and talk about it consistently, you can establish momentum," he says.

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