By: Christine Whitmarsh
As part of the overall medical management healthcare team in area hospitals, in addition to the CEO, the physicians who are elected to or hired into the role of Chief of Staff or Chief Medical Officer play an important role in providing a communication line between the medical staff and management departments within the hospital. The medical and management departments are both vital parts of any hospital and it is very important to the quality of care provided that they work together fluidly.
Business Life spoke with several physicians from four area hospitals who currently serve in these roles to learn more about what their jobs entail, how it affects overall care at the hospital and the current challenges they are facing.
Dr. Warren Churg was recently elected Chief of Staff at Glendale Adventist Medical Center, beginning his term on January 1st of this year. Dr. Churg says that a good Chief of Staff has experience in healthcare administration as well as in departmental supervision. This comes to play in the chief’s responsibility to help integrate overall care delivered by all the hospital’s departments. Dr. Churg’s job duties also include: ensuring that all care meets the hospital’s standards through the process of peer review, coordinating workable policies and procedures and managing staffing needs.
He sees much of his value as Chief of Staff related to his 27 year tenure at Glendale Adventist, time which he has made good use of.
“I’ve seen healthcare, our medical staff and our institution growing over the years, I’ve spent time interacting with our staff and worked with a lot of different people at lots of different levels,” he says.
For Dr. Leo Berkenbile, Chief of Staff at Verdugo Hills Hospital since October of 2005, working with many different people and dealing with problems is already a part of his job as director of the emergency department. As chief, he uses that experience as well as his leadership experience from having served on several of the hospital’s committees, to bridge the gap between physicians and board members.
The job description for a hospital Chief of Staff is similar to that of a Chief Medical Officer.
“The main value of the job is my ability to bring the physicians, administration and hospital together to focus on and align our energy towards improving quality and safety at our hospital,” says Dr. Bernard Klein, Chief Medical Officer for Providence Health and Services, San Fernando Valley service area.
Included within the scope of the job, is the CMO’s responsibility in overseeing quality improvement throughout the healthcare system, managing the medical staff office (which is responsible for maintaining physician credentials) and supervising the medical education department.
Much of the public may not realize that the majority of doctors who practice at a hospital are not actually employed there. They are employed in private or group practices outside of that hospital, and have “privileges” to practice at the hospital. One of the major differences between a Chief of Staff and a CMO, is that Chief of Staff is an elected position with terms of tenure (typically two years), while a CMO is a full time employee of the hospital.
Dr. Klein was hired in November of 2004 as CMO for Providence Health System, which includes Saint Joseph Medical Center and Burbank and Providence Holy Cross in Mission Hills, amongst the organization’s other local facilities. He lists the typical criteria that a hospital uses in hiring a CMO, as including: 5-10 years of clinical practice experience, established clinical credibility with the hospital’s medical staff, excellent communication skills and the ability to motivate and collaborate with others. He adds that some type of business administration experience like an MBA or the equivalent is helpful, but not required.
Dr. Klein says his biggest challenge right now is balancing the public’s increasing demand for higher quality of care with the intense pressure from the hospital to control and reduce costs without compromising patient care or safety in the process.
“Our doctors are seeing increasing demands on their time with decreased reimbursement,” he says.
In response to this challenge, Dr. Klein describes the “quality strategic plan” developed by Providence Health System. The plan provides an organizational vision as to where they want to be and then details how to focus resources around it.
“We need to keep our doctors engaged and aligned with the hospital mission to provide top quality, safe care while at the same time serving our mission of caring for the poor and vulnerable,” Dr. Klein says.
Dr. Paula Verrette is Huntington Memorial Hospital’s Vice President of Quality and Performance Improvement. Her job is similar to CMO and Chief of Staff in that she also works closely with administrative and medical staff to achieve excellence throughout the hospital.
Dr. Verrette is also responsible for translating often complicated quality control data about the hospital’s overall performance, in a way that the public can understand.
“The public wants to know how clinical research translates to them. They read the research and want to know what it has to do with their medical needs,” Dr. Verrette says.
Verrette was hired to the position in January of 2007, at first in a part time role to help facilitate her move away from private practice into the full time demands of overseeing the continuous and relentless pursuit of quality improvement at Huntington Hospital in Pasadena.
She sees one of her greatest challenges as reconciling the “likeability scorecard” the public seems to use to evaluate their doctor’s performance with the actual criteria they should be using.
“The public’s using ‘Zagat ratings’ to evaluate doctors is getting us further away from our goal of excellence in care. We need to inform the public what they are supposed to be rating - clinical competency, versus the idea of just liking their doctor’s personality,” Dr. Verrette says.
Many of the doctors interviewed, cited this year’s presidential election as a key factor in determining the future of healthcare – locally and nationally.
Verdugo Hospital’s Dr. Berkenbile says that 50% of hospitals in California are currently losing money and the ones who are making money are “barely hanging on.”
“Medical expenses are very high and we’re teetering on the edge of many hospitals not being able to make it,” says Dr. Berkenbile.
Dr. Churg at Glendale Adventist adds, “This year’s election will have an impact on how we deliver healthcare, who gets access to it and how we get reimbursed for it. Our ability to deliver care and keep hospitals surviving is an immense challenge.”
Glendale Adventist Medical Center
Dr. Warren Churg—Mortality rates for Glendale Adventist patients needing cardiac surgery are not only lower than would be expected for the complexity of the cases, but they are the lowest in the area. GAMC is also proud to be one of the only hospitals in the area to provide the community with all of the components of a Primary Stroke Center.
Huntington Memorial Hospital
Dr. Paula Verrete
Huntington Hospital is the first health care facility in the San Gabriel Valley to open interventional radiology suites that house state-of-the-art angiography suites with bi-plane Toshiba technology. One of the newly renovated suites is specifically designed and designated for neurovascular intervention. The other suites will be dedicated to other diagnostic and interventional procedures.
Providence Saint Joseph Medical Center
Dr. Bernad Klein
The Roy and Patricia Disney Cancer Center will be San Fernando Valley’s most comprehensive cancer center when it opens in early 2009. The Providence Saint Joseph Foundation is also in the midst of an $11 million campaign to build a neuroscience institute, one of only two in Los Angeles County.
Providence Holy Cross Medical Center
Providence Holy Cross Medical Center was recently designated “Baby-Friendly” by Baby-Friendly USA. This recognizes them for providing an optimal level of care and information for breastfeeding mothers. Also, groundbreaking will be held this year on the new 101-bed South Addition that will make Providence Holy Cross the second largest hospital in the San Fernando Valley with 355 beds.
Verdugo Hills Hospital
Dr. Leo Berkenbile
Verdugo Hills Hospital has introduced a new 24/7 fast-track service in its Emergency Room for non-life-threatening injuries and illnesses to help patients get triaged, treated and discharged faster. The type of conditions suitable for fast-track service include simple lacerations, sprains and strains, coughs, headaches, fever and rashes, colds and flu, and similar diagnoses.