The CMO’s Role in Better Outcomes

00:00:00:00 - 00:00:17:00
Tom Haederle
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."

00:00:17:03 - 00:00:34:08
Chris DeRienzo, M.D.
I'm Dr. Chris DeRienzo, 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.

00:00:34:10 - 00:00:39:17
Phillip Chang, M.D.
Chris, delighted to be here. And good to catch up again.

00:00:39:19 - 00:00:52:22
Chris DeRienzo, M.D.
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. CommonSpirit Health.

00:00:52:24 - 00:01:30:19
Phillip Chang, M.D.
Absolutely. So, again, my name is Philip Chang. I'm the chief medical quality officer for CommonSpirit Health. And what I really love about CommonSpirit is the first and foremost it's 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 in Houston, of advanced cardiac surgery and one of the premier liver transplant programs.

00:01:30:19 - 00:01:54:02
Phillip Chang, M.D.
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.

00:01:54:04 - 00:02:18:01
Phillip Chang, M.D.
I think 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 that because I think many of us have, because the impact that we're able to make both is multifaceted and it's significant, right?

00:02:18:01 - 00:02:37:12
Phillip Chang, M.D.
And we think about patient impact, but we also think about medical staff impact. Now we call it physician well-being, which is also so important. But then the ability and the necessity to interface with the clinician administrators so that we can all work together - that that drew me to it.

00:02:37:15 - 00:02:56:21
Chris DeRienzo, M.D.
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, you know, we discovered in a paper that we wrote last fall that that effectively defines the leadership experience for college,

00:02:56:21 - 00:03:14:07
Chris DeRienzo, M.D.
you know, our vintage of chief physicians today. And it's the responsibility of folks like you and me and leaders and health systems across the country to try to make that difference. But in order to get there first, folks have to understand what job like yours actually look like. And yours is a pretty big one. So walk us through briefly a little bit,

00:03:14:14 - 00:03:20:28
Chris DeRienzo, M.D.
you know, your team at CommonSpirit. And what does a typical day look like for you as the chief medical and quality officer?

00:03:21:00 - 00:03:47:25
Phillip Chang, M.D.
We're looking at our team, and our team is obviously a number of very, very, strong experts in quality and safety, patient process improvement. But I also have a little liaison to interface with all of our chief medical officers. We have region, market, and then sites and how we work together. And the management structure is come in place.

00:03:47:25 - 00:04:14:17
Phillip Chang, M.D.
But I also have a, small but very mighty team of like minded clinicians, and they really push CommonSpirit 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 as a continuous cycle. So we've got the data monitoring.

00:04:14:20 - 00:04:44:22
Phillip Chang, M.D.
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 ten months, nine, ten 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.

00:04:44:22 - 00:04:54:24
Phillip Chang, M.D.
So when I was operating a lot my kids knew if I'm there operating, you know, I'm at work. Now that's in the office, home office.

00:04:54:27 - 00:05:14:09
Chris DeRienzo, M.D.
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 ten months into the role, you know, I'm curious what you described as this very powerful cycle. And it becomes a flywheel of, of leading people through change.

00:05:14:12 - 00:05:20:06
Chris DeRienzo, M.D.
What is the biggest challenge that you're tasked with leading your teams through right now?

00:05:20:09 - 00:05:48:21
Phillip Chang, M.D.
Yeah, I think biggest challenge, and these are all fun challenges from my sort of vantage point. But we, we want to really think about how we redefine, how we measure what is high quality of care? But, you know, in addition to the traditional benchmarks that we all look after, right? There's, you know, CMS has health grades and the star ratings.

00:05:48:24 - 00:06:13:15
Phillip Chang, M.D.
I really think about what does it mean to CommonSpirit when we serve our community, what's right? And I'm not saying we're inventing new measures all the time and altogether. I'm saying that beyond the sort of overarching, okay, there are there are complications or there's, you know, patient safety indicators that we measure. What are other things that our patients might care about.

00:06:13:17 - 00:06:34:17
Phillip Chang, M.D.
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 paradigms got to shift, right? We used to be okay with the doctor will see you now. Now it's well, I'm ready for the doctor to come see me.

00:06:34:19 - 00:06:38:28
Phillip Chang, M.D.
And we really have to think that way because I think our patients deserve it and they expect it.

00:06:39:00 - 00:07:04:24
Chris DeRienzo, M.D.
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 know, 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, you know, a large center in Atlanta with a multi-tiered emergency department can serve.

00:07:04:26 - 00:07:43:20
Chris DeRienzo, M.D.
But defining that North Star and how you want your communities to experience it, that that's a big challenge. You describe a little bit of your pathway, to becoming a leader and becoming the CMQO at CommonSpirit. 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 based on that framework that we wrote about in the NEJM Catalyst that you needed to be successful doing what you do today.

00:07:43:23 - 00:08:12:07
Phillip Chang, M.D.
I was at the time an associate chief medical officer at University of Kentucky. I was, I was the perioperative medical director. The chief medical officer position opened up. It was primarily an internal search, or at least in the end all the candidates were internal. And we're going through a number of interview process, and I go, well, you know, I managed an operating room for five years, and if I could do that with that group of characters, I could do the hospital.

00:08:12:09 - 00:08:38:16
Phillip Chang, M.D.
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 measurement, why should we believe in it, you know, and, and tell us the nuances about it. And it took me aback and, fortunately I had the job despite me fumbling through that question, but I really doubled down.

00:08:38:19 - 00:09:14:05
Phillip Chang, M.D.
Okay. This is not something, at least at the time, that we have ever measured in the operating room. It was always a serious safety event, and it was all about volume through put, long 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 CommonSpirit as well is how do we take a set of data's. You know, chief medical officer, chief quality officers, and I believe this is going around now.

00:09:14:12 - 00:09:42:13
Phillip Chang, M.D.
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 are responsible for. And if you look at the CFOs charts, it's very clean, it's very standard because they have a shared common currency called US dollars.

00:09:42:16 - 00:10:05:04
Phillip Chang, M.D.
We are thinking through a lot of this in this, in this sort of fashion so that we're delivering usable information to our frontline, both ambulatory side, primary care service lines in the hospitals, obviously, and to say, okay, well, you are performing better than last year, but you're not performing fast enough compared to your peers inside CommonSpirit.

00:10:05:06 - 00:10:06:19
Phillip Chang, M.D.
So how can we help?

00:10:06:21 - 00:10:32:15
Chris DeRienzo, M.D.
You're all in. 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 had the same kinds of accountability is often shared with other clinical leaders, but very, very rarely have all of the levers that they can directly pull to drive that change.

00:10:32:15 - 00:10:51:05
Chris DeRienzo, M.D.
Yeah. I'm curious, looking back at your career so far, is that the one thing that you wish that, that you had had learned earlier, or is there something else that that you wish you looking back at pre-associate CMO Phil, even, you know, trauma surgeon Phil. What one thing do you wish he knew that you know now?

00:10:51:08 - 00:11:14:21
Phillip Chang, M.D.
You know there's so many but I would say the one thing and to any sort of future CMOs is 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, and, and I think it's not just for CMO, really, it's for any one of us who are giving ourselves, burning the candles for our patients.

00:11:14:27 - 00:11:20:15
Phillip Chang, M.D.
I think it's important to take a moment and spend some time with your family and take care of yourself.

00:11:20:18 - 00:11:39:29
Chris DeRienzo, M.D.
That is a spectacular note to end it on, Phil. And one that's 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.

00:11:40:05 - 00:11:56:11
Chris DeRienzo, M.D.
We're using AI enabled solutions at the points 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.

00:11:56:13 - 00:12:04:24
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.