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- [00:00]
A
Welcome to Advancing Health. In this discussion, we learn more about the role of the Chief Medical and Quality Officer, an influential position in many hospitals and health systems that's been described as a powerful cycle of leading people through change.
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B
I'm Dr. Chris Girienzo, the Chief Physician Executive for the American Hospital association. And today I am incredibly excited to be joined by Dr. Philip Chang. He serves as the Chief Medical and Quality Officer for Common Spirit Health. Phil, thank you so much for joining the series.
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C
Chris, delight to be here and good to catch up again.
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B
Likewise. Before we jump in, we've got a standard set of five questions, but before we get into the questions I always like to ask, tell us just a little bit first about yourself personally and about the health system that you serve. Common Spirit Health.
- [00:53]
C
Absolutely. So again, my name is Philip Cheng. I'm the Chief Medical Quality Officer for Common Spirit Health. And what I really love about Common Spirit is that first and foremost is mission driven. For me, if we were to geek out a little bit in the acute care side, for instance, we have small critical care access hospitals all the way to large academic hospitals with transplant and the whole works such as you may know Baylor St. Luke's sort of the birthplace of Houston of advanced cardiac surgery and one of the premier liver transplant programs. But we also think that equally important to something as prestigious as Baylor St. Luke's we have critical access hospitals where we anchor the community and the health they receive. So I'm very proud of that fact. My background, I'm a trauma surgeon by training, sort of stumbled into quality safety and the chief medical officer land. I think we'll talk about this a little more. But I didn't grow up thinking, my gosh, I want to be a cmo. I sort of joined the medical staff and go, who's the CMO guy? But I gravitated towards it because I think many of us have because the impact that we're able to make both is multifaceted and it's significant. We think about patient impact, but we also think about medical staff impact. Now we call it physician well being, which is all so, so important. But then the ability and the necessity to interface with non clinician administrators so that we can all work together. That drew me to it.
- [02:37]
B
I was just going to get to that actually, because you hit on something that is driving this, which effectively is. So many of us wound up in leadership, it was less of an intentional journey. And we discovered in a paper that we wrote last fall that effectively defines the leadership experience for college. Our vintage of chief physicians Today. And it's the responsibility of folks like you and me and leaders in health systems across the country to try to make that difference. But in order to get there first, folks have to understand what jobs like yours actually look like. And yours is a pretty big one. So walk us through briefly a little bit, you know, your team at Common Spirit and what does a typical day look like for you as the chief medical and quality Officer?
- [03:21]
C
We're looking at our team and our team is obviously a number of very, very strong experts in quality and safety, patient process improvements. But I also have a little liaison to interface with all of our chief medical officers. We have region, market and then site and how we work together. And the management structure is coming in place. But I also have a small but very mighty team of like minded clinicians and they really push Common Spirit to think through what the right clinical standards should be based on evidence based medicine. Obviously we leverage all the experts within our organization so that I like to think of it as a continuous cycle. So we've got data monitoring, we detect things that we believe we can improve on, bring it over to clinical standards, revise the standards and then take it to the CMOS so they can help us execute and that cycle continues. As you know, I'm fairly new at this role. It's now going on about 10 months. Nine. 10 months. So I'm building some of these bridges and this collaborative sort of spirit I like to think about not necessarily as the typical day. I'll tell you a funny story. So when I was operating a lot, my kids knew if I'm there operating, you know, I'm at work now, Dad's in the office, home office.
- [04:55]
B
Well, sometimes you're there and sometimes you're in hospitals and sometimes you're in convention centers. I mean, I know your travel schedule looks, looks a lot like mine, but being 10 months into the role, I'm curious what you described as this very powerful cycle and it becomes a flywheel of leading people through change. What is the biggest challenge that you're tasked with leading your team through right now?
- [05:20]
C
Yeah, I think biggest challenge, and these are all fun challenges from my sort of vantage point. We want to really think about how we redefine how we measure what is high quality of care. You know, in addition to the traditional benchmarks that we all look after.
- [05:43]
B
Right.
- [05:44]
C
There's, you know, CMS has health grades and the star ratings. I really think about what does it mean to Common Spirit when we serve our community, what's right. And I'm not saying we're inventing new measures all the time. And altogether, I am saying that beyond the sort of overarching, okay, there are complications or there's patient safety indicators that we measure, what are other things that our patients might care about? And I know it is patient experience, but I also think it is a little bit of our promise to the patient to be able to deliver care at their level, at their time, not our time. That paradigm's gotta shift, right? We used to be, okay, what the doctor was to you. Now now it's, well, I'm ready for the doctor to come see me. And we really have to think that way because I think our patients deserve it and they expect it.
- [06:39]
B
One thing I've grown to appreciate deeply since I joined AHA about four years ago is that every health system serves a unique role in their communities. And the role that you just described, that a critical access hospital serves as an anchor in a very rural community, maybe only with a couple of patients inpatient every day, is both the same and different from a role that a large center in Atlanta with a multi tiered emergency department can serve. But defining that North Star and how you want your communities to experience it, that. That's a big challenge. You described a little bit of your pathway to becoming a leader and becoming the CMQO at Common Spirit. My path was similarly circuitous, as are many of our peers. And so I'm wondering if you can speak to either one person or one experience that you didn't plan for, but that fundamentally helped you develop either the knowledge, the expertise, or the experience. And based on that framework that we wrote about in NAGM Catalyst, that you needed to be successful doing what you do today.
- [07:44]
C
I was at the time an associate chief medical officer at University of Kentucky. I was the perioperative medical director, the chief medical officer, physician, opened up. It was primarily an internal search, or at least in the end, all the candidates are internal. And we're going through a number of interview processes. And I go, well, I manage an operating room for five years, and if I could do that with that group of characters, I could do the hospital. And I was asked a question during the. During the process. And it was really about quality framed as, why is the CMS sort of quality measurements? Why should we believe in it, you know, and tell us the nuances about it? And it took me aback. And fortunately, I got the job. Despite me fumbling through that question. But. But I really doubled down on, okay, this is not something, at least at the time, that we have ever measured in the operating room, it was always serious safety event and it was all about volume, throughput on time, turnover time, etc. So I really just put my head down and learned as much as I could and understand the nuances of it. And I think that's really helped me in my career. Because a lot of what we're thinking about at Common Spirit as well is how do we take a set of data? Chief medical officer, chief quality officers, and I believe this is going around now. We're beginning to think of ourselves as sort of the CFO of quality measures because we are presenting data in a coherent way to those who can directly impact and improve the unit that they're responsible for. And if you look at the CFO's charts, it's very clean, it's very standard because they have a shared common currency called US Dollars. We are thinking through a lot of this in this sort of fashion so that we're delivering usable information to our frontline, both ambulatory side primary care service lines and the hospitals, obviously. And, and to say, okay, well, you are performing better than last year, but you're not performing fast enough compared to your peers inside Common Spirit, so how can we help?
- [10:07]
B
You're all in it. And you know, I love to geek out, Phil, and I love your analogy, in part because CFOs are accountable for the financial health of an institution, though they have very, very little direct ability to impact it. And to your point, chief medical officers and chief physicians have the same kinds of accountabilities often shared with other clinical leaders, but very, very rarely have all of the levers that they can directly pull to drive that change. I'm curious, looking back at your career so far, is that the one thing that you wish that you had learned earlier, or is there something else that you wish you're looking back at? Pre associate CMO Phil, even trauma surgeon Phil. What one thing do you wish he
- [10:50]
C
knew that you know, now you know, there's so many. But I will say the one thing, and to any sort of future CMOs out there, take care of yourself, you know, for all of us. Even though physicians are, you know, we take on a lot, mentally and physically, and I think it's not just for CMOs really, it's for any one of us who are giving ourselves burning the candles for our patients, I think it's important to take a moment and spend some time with your family and take care of yourself.
- [11:21]
B
That is a spectacular note to end it on, Phil, and one that again, I think when I speak to medical students and residents today, I tell them you could not have picked a better time to be coming into medicine. First of all, we went through digital transformation over the last 25 years and the electronic records that we're working in are much better than the digitized paper versions we started with. We're using AI enabled solutions and at the point of physician and clinician experience, and we have a different appreciation for the negative axis of burnout and the positive axis of well being. And crucially, folks like you are leading the way to do something about it.
- [11:56]
A
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