Physician executive offers advice from the front lines - Career Management - Interview

Physician Executive, May-June, 2003 by Mary Frances Lyons

Rod Hochman, MD, is on the front lines of physician leadership as CMO for Sentara Health and CEO for Norfolk General Hospital, the anchoring tertiary-care hospital in the Norfolk/Hampton Roads area of Virginia.

Recently, I questioned Hochman about a number of issues that aspiring physician executives face as they move through their professional development. I think you'll find his comments interesting and thought-provoking.

Sentara is nationally recognized as the No. 1 or No. 2 health care system for overall performance and innovation.

Why should a physician strive to reach an executive role?

Hochman says it's a leadership issue--and more. He notes that physicians were recognized as leaders way back when they were accepted into medical school--but that alone, he adds, is not enough to make the difference in the complex world of health care management.

"Physician executives who are going to succeed in the executive suite have to do more than want to be CEO. They must have an agenda they can put in place more effectively from the executive side.

"They need to articulate a clear vision while being able to combine clinical acumen with the business realities to improve health care delivery. It gets them out of the office and offers the opportunity to make bold, exciting decisions about what to support, what to finance. Bringing others to the same vision takes considerable time--it's the broad leadership challenge faced by all high-level executives."

What are some major differences between general and medical management?

Hochman acknowledges that with the role of general manager come many responsibilities that have nothing to do with anything he learned in medical school.

"I have responsibilities and decision making in plant and facility maintenance. I have a highly capable VP who is the lead person in that area, but nevertheless, I need to understand enough to make good decisions. The implications are considerable. Think about the upside of knocking off $3.5 million in supply chain management!

"Since I don't have expertise in this area, it highlights the importance of having the right materials management executive. Additionally, I spend a lot of my time on labor relations, looking at wage scales and shifts and how decisions might affect the unions. The work force has changed, as has the way we deal with them. About 20 or 25 percent of my time is spent on labor force issues."

What are the greatest challenges in medical management?

Hochman emphasizes the challenges of limited resources, limited capacity and growing demand for services.

"As a clinician, I understand which patients can go home and when. That's a major advantage when we're trying to care for a patient population with an increasing demand for services. Sometimes, issues have substantial impact on resource availability--for example, a physician who goes to multiple hospitals and has a sicker patient panel privileges will likely have a large inpatient population. That physician may not see patients first thing, and his or her discharges will take place later in the day, limiting bed availability.

"Every principal plays a role in the bureaucracy of moving patients through the system--physicians, nurses, transport, etc. For example, the discharges from my facility are usually around 50 per day. Now, one day we had a pseudo-snow day and operated as though we were heading into the kind of blizzard that would have paralyzed the region for several days. The physicians acted differently; the hospital functioned differently, and patients' expectations were different, too. They didn't want to be in the hospital any longer than necessary; they wanted to go home. Housekeeping and transport mobilized. That day, we discharged 90 patients. What changed? Why can't we do that every day? This was the equivalent of adding between 50 and 100 beds in capacity!

"This has become my 'stump speech.' In talking with physicians, it is now more straightforward to highlight the negative impact on the hospital of late discharges and the favorable impact of frequent rounds. Clearly, it makes sense to involve hospitalists for early discharge planning.

"When we talk with them, the surgeons see the advantages of medicine patients moving through the system and not spilling over into surgery beds, which limits the admissions of their surgical patients. The medical staff is now behind this kind of thinking and in full support of a higher level of clinical operations.

"I know the fact that I am myself a clinician has made a difference in being able to convince them of these imperatives."

What other challenges do you face?

"Another key issue is patient safety. We are one of the inaugural systems using VISICU, an electronic ICU. Much has been written about it and its potential. A large part of our patient safety efforts have been more common sense and mundane. We have begun to subcompartmentalize much of our high-volume/high-risk care areas, like the cardiac units, vascular surgery and neurosurgery.

For example, the LVADs were taking up beds that could not then be used for straight open heart cases. Figuring out how to put those in a different category and on a different trajectory has allowed us to reallocate resources in ways that allow for better care, safer patient management, better outcomes--and no bottlenecks.