TRANSITION: FROM THE CLINICAL TEAM TO THE EXECUTIVE TEAM – ONE YEAR LATER: LESSONS LEARNED Richard J. Flaksman, MD, MBA, CPE April 2013 OhioHealth Marion General Hospital Marion, Ohio

22 BACKGROUND Senior Neonatologist, 33 years full-time clinical practice with other administrative responsibilities Earned CPE designation 2004 Earned MBA (UMass-ACPE) 2009 Interim Director of Medical Affairs at local hospital, Appointed Hospital Vice President of Medical Affairs, August 2011 Continued staffing maternity and special care nursery one weekend a month What are some lessons learned? This poster describes a clinician’s experience the first year after transitioning from the Clinical Team to the Executive Team

33 MAJOR ROLE CONSIDERATIONS For whom does the VPMA speak? – Medical staff – Hospital administration – Non-physician hospital staff – Parent health system (if part of a system) – Patient – Public face of the hospital to the community To whom does the VPMA report? – Direct and indirect reporting lines –System CMO –Hospital CEO/President If considered a member of the senior executive team, then interact with other execs

44 MAJOR ROLE CONSIDERATIONS (cont’d) Maintenance of Clinical Practice How to balance administrative and clinical time: If the VPMA is fulfilling one role, is the other one excluded (e.g., being called for a clinical emergency)? How much clinical activity is sufficient to: – Enable you to maintain clinical skills? – Give you “street credibility”, i.e., not being “just another suit”? Quality Activities In most institutions, the VPMA is responsible for overseeing the quality of care provided to patients. – Is there sufficient non-physician staff support (Director of Quality, quality analyst, information technology specialist)? – Does the VPMA have the trust/confidence of medical and non-medical staff to address quality issues? This may include interventions, peer review activities, physician conduct/health activities (management of physician performance)?

55 TANGENTIAL TO THE ABOVE ARE: Credentialing – We are taught in MPP that “doing the credentialing right the first time reduces future physician performance issues” Scheduled Peer Review Activities (service- specific, departmental, multispecialty/hospital-wide) – The VPMA may be an ad-hoc member, guest or a permanent member, voting or non-voting. Drop-in Activities – Do you maintain an “open door” policy?

66 HOW DO YOU PREPARE FOR THE ROLE? Need a clear understanding of job description and accountabilities! – Education, degrees, certification - only go so far, i.e., they are not community/job-description specific (helpful to take “VPMA-oriented” courses or simulations, if available, such as MPP or CPE tutorial). – Education gives you the general tools and knowledge base, especially being able to understand and speak the language of business and medical staff management. – The rest comes from prior experience in the role, if you have some, or simply OJT.

77 WHAT ABOUT THE TIME COMMITMENT? Committees – Ad hoc member of some, scheduled member of others – Ex-officio? Voting member? – Committees have: Meetings!! – Not always during “business hours” (early morning, evening) – Service line section, department and medical executive committees locally (board?) – System-Clinical/Physician leadership teams – Other system-wide teams/committees (may entail driving: adds extra time to meetings)

88 WHAT ABOUT THE TIME COMMITMENT? (cont’d) Administrator-on-call? – Even when off call, could be called by another administrator due to clinical background Preparation for Regulatory Surveys – The Joint Commission/CMS/State or local health department

99 BE A CHAMPION OF CHANGE Why change? Societal priorities change, regulations change, reimbursement changes - many of these occur quickly and are beyond our control. We physicians don’t embrace change easily: we are used to doing what works. It is easy to rely on our own experience. It is sometimes harder to be innovative. The VPMA should respect the needs of both the medical staff and the hospital/clinic/system, support collaborative change. Examples: Changing from a paper health record to an electronic one, standardizing order sets to reflect best practices, working with quality indicators promulgated by regulatory agencies (readmissions, HAIs, etc) CHANGE OR BE CHANGED!

10 KNOW THE COMMON RULES AND REGULATIONS The Medical Staff makes the rules! The Medical Staff enforces the rules! – Ability to work with medical staff leadership in this area is paramount. Is the VPMA a “facilitator” or a “hammer?” (Remember: the Board is ultimately accountable). – Medical Staff By-laws and policies: KNOW THEM (and/or have them close at hand) and understand how they interface with nursing or other service policies. – Have a working knowledge of other rules, laws and regulations, e.g., STARK, EMTALA, CMS, TJC, state and local.

11 LEARN THE CULTURE OF YOUR COMMUNITY Being or having been part of the medical community may or may not be helpful, or could work against you. History of physician practices, hospitals, clinics. Is the physician-hospital relationship collaborative or competitive? Is there alignment? Are there unresolved or lingering issues? Is the medical community itself united or divided? Is there friction between groups – hospital-employed v. community group(s) v. community independent(s)? Where are the “land mines?” Is there someone who can alert you to them? Other execs? Medical staff leaders?

12 YOU NEED A SUPPORT SYSTEM (It’s Lonely Out There) Your “boss” - CEO, CMO, Executive VP Professional coach? Advisor? Other VPMAs (networking helpful) Hospital/system legal counsel Family Personal physician?

13 IN THE END, IT’S ALL ABOUT RELATIONSHIPS (or a good portion is) Administration Medical staff leadership Individual medical staff members Nursing leadership Non-physician department heads/ directors/managers Support services Be available! Don’t stick yourself behind a desk. Be accessible and visible, including after hours.