CQO role offers broad leadership challenges - Leading Questions - chief quality officer

Physician Executive, July-August, 2003 by Scott Ransom

Some assume that leadership is exclusively the job of the chief executive officer, the individual at the top of the organization. Of course, that's not true--leadership is a vital component for many other senior clinical and management roles.

Without strong leaders in finance and information services, for example, most organizations would falter. For physician executives, a position has emerged in the past few years that may be tailor-made for their leadership--the chief quality officer (CQO).

Unfortunately, the CQO role in some quarters acquires an undeserved reputation as a career sidetrack. Perhaps it's been designed as a pre-retirement "perk" for a worthy, if slowing-down, physician.

In that case, the CQO role will be largely ceremonial, with little genuine ability to impact organizational quality. But those positions should not cloud your perspective on the real challenge represented by the role of the CQO in today's pre-eminent health care organizations.

When established and supported properly, it's a vital and invigorating position with no wasted time or talent. Optimally, the CQO role calls upon every bit of a physician executive's experience and abilities--and even can stretch some previously unexercised executive muscles.

Broad in scope and far-reaching in its power, a CQO position can truly be an ideal career goal for the skilled physician executive. In the interest of full disclosure, I was once myself a CQO in a hospital system. It was an interesting time.

Primary CQO skills

Based on what health care organizations demand of CQO candidates these days, I believe a successful CQO must possess these five key skills:

1) Leadership of change management

This is a job for an individual who wants to wake up the organization. No more "same old, same old." No tolerance for errors and their consequences for patient safety. A great CQO has a passion for improvement, does not revere the status quo, understands the essential linkage between financial performance and quality care, admires efficiency and can communicate a broad vision of a better future to others, at every level of the organization.

2) Ability to change physicians' performance and behavior

Physicians have enormous clout and it requires a great deal of work and skill to convince them to change. They're not natural team players and must learn to see the importance of the process of quality, not just for individual procedures but for every procedure. And, yes, before they accept changes for quality physicians may claim: "But my patients are sicker!" Despite their best efforts at resistance, an effective CQO will generally be able to motivate physicians' behaviors and manage their concerns.

3) Knowledge of the organization's processes

Because the CQO understands the modern--and extremely complicated--health care facility, he or she knows where the problems are and can effectively root out waste and error, whether in medical errors or in nursing service or pharmacy practices. In my own work as GQO, for example, we determined that only about 33 percent of C-section patients were receiving antibiotics--because there were a crushing 22 steps to take between the decision and administration of the drugs. After changes were made, 95 percent of the C-section patients received their antibiotics in a timely manner. Similarly, by stocking antibiotics on the floor of the emergency room and having registered nurses administer the drugs, we reduced a lengthy wait for pneumonia patients.

4) Ability to collect and analyze data, and communicate findings

The CQO converts data to useful information to help identify areas for quality enhancement. This is not done in a technical, "robocop" way because this is much more than epidemiological and biostatistical tinkering. The CQO must understand how to extract data, conduct appropriate analysis, develop an operational plan and sell ideas. The CQO should regularly meet with the CEO and the board, and be able to use data to communicate concepts of change.

5) Understand and be able to implement "Crossing the Quality Chasm"

Some CQOs lead from previously developed templates, such as the Baldrige Award criteria or from the Institute of Medicine's, "Crossing the Quality Chasm: A New Healthcare System for the 21st Century." These established objectives appear to be ideally suited for physician executive leadership. Whether or not you will ever be a candidate for a CQO position, reviewing these reports will provide a stimulating charge. The ability to implement the six hallmarks of quality care listed in the TOM report is frequently discussed prior to making a hiring decision for a new CQO. Top CQOs have practical ideas of how to implement positive change, to ensure that health care is safe, effective, patient-centered, timely, efficient and equitable.

What to consider in the CQO role

Some organizations tap non-physician general administrators for the CQO role. Of course, the focus of the job depends on the organization's goals. If they want to run a "data shop," then they usually don't want a physician executive. They also probably don't want a leader, either.