More doctors, nurses becoming hospital administrators

Posted Saturday, Oct. 12, 2013  comments  Print Reprints

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Take a close look at how medical care is being delivered, and it’s clear that doctors and hospitals are being asked to work more closely together to maintain quality even as payments start to shrink.

If that’s the case, would it help if more hospital administrators were also clinicians – doctors, nurses and other health professionals? Quite a few in the industry apparently think so.

Today, Tarrant County has the unusual circumstance of its two biggest hospitals, Texas Health Harris Methodist Fort Worth and Baylor All Saints, being headed by clinicians. Both hospitals are in the Fort Worth medical district.

Lillie Biggins, president of the Texas Health hospital, is a registered nurse who started her career in an intensive care unit. And her immediate superior, Jeff Canose, who oversees operations for the Texas Health Resources’ southwest region that includes 12 hospitals, is a physician.

Not only that, but each of THR’s three regions has two chief officers, one for operations and one for clinical matters. THR’s southwest region is the only one headed by two physicians.

The Arlington-based health system last year adopted a policy of moving clinicians into top management posts as one way to “enhance our ability to connect the dots along the care continuum,” as THR CEO Doug Hawthorne put it at the time.

Down the road at Baylor All Saints, David Klein took the reins earlier this year. He’s a surgeon who spent 14 years in practice before getting an MBA and spending the past 10 years in administration.

Those hospitals aren’t alone.

Merritt Hawkins & Associates, a big health professionals recruiting service based in Irving, reports that it’s getting more requests for people with experience in both the clinical and administrative realms. It doesn’t keep data on what degrees top administrators hold, other than Master of Health Administration, which is the most common.

“We have seen it the last two or three years,” Travis Singleton, senior vice president at Merritt Hawkins, said of hospitals’ interest in executives with clinical backgrounds. “Our reimbursement system is changing.”

Governments, insurers and the big employers who write the checks for most of the healthcare in the United States all want the medical system to take responsibility not just for delivering that care, but for its results and cost as well. Employing adminstrators with medical experience puts hospitals in a stronger position to weigh both sides of the health care equation.

One of the most visible examples of that is the Accountable Care Organization, an affiliation of doctors, hospitals and other providers who agree to manage the health of whole groups of patients for a set amount of money. That raises questions: How will the money divided among the various providers? Who determines treatment protocols, such as when and how many tests are done? What procedures have the best outcomes for the lowest cost? How much emphasis will go to getting patients to follow the doctor’s instructions, not to mention adopting preventative measures aimed at heading off future health problems?

That’s a big change from the historical fee-for-service model, where independent physicians and other providers made decisions about what to do and then sent the bill to the insurance company or Medicare.

“You’re going to look these doctors in the eye and tell them, ‘I want you to deliver care this way.’ If I’m a doctor, I’m going to listen to someone who’s done it,” Singleton said.

Building trust

There’s a trust element to it all, Biggins said.

“We all know there’s going to be less dollars” to go around, she said. “We’re going to have to look at the patient and trust each other and dialogue so we can create a model of care. We have clinicians in these key roles, and that’s when we have the edge.”

Asked for a concrete example of how clinical background affects administrative decisions, Biggins and Canose both pointed to the Fort Worth hospital’s new emergency department. The $57 million project, expected to open in January, is roughly triple the size of the existing facility, which had become crowded.

“Just financially, we would have gone through a renovation in place,” Biggins said, and that was the first approach. “But the length of time it would take, the impact on patients” also had to be considered, she said.

“It makes sense not to have patients lining the hallways” in the middle of a construction project, she said. So the thinking started to change in favor of a new building, one connected to the main hospital by a skywalk.

Then there were decisions to be made on what equipment to install. For example, did it make sense to spend the extra money for the latest and greatest computed tomography (CT) scanner? The hospital could always simply pass along its higher costs to the people who pay the bills, just as hospitals have done for decades.

“On numbers alone, it should be installed tomorrow,” said Canose. “But on the grounds of, ‘Does it make sense in the manner we are going to practice medicine in the 21st century?’ it’s not there yet,” he said.

Cardiologists can use the scanners for images of the heart that they can search for clues. They might justifiably argue that they need every tool they can get their hands on.

But again, “there’s new thinking about how chest pain should be managed,” Canose said, and existing CT technology may be up to the task when it comes to heart procedures. “It’s the cardiologists who are tapping the brakes,” he said.

“There’s a growing recognition that we have taken healthcare about as far as we can building better facilities. We need physicians and nurses partnered with us to make care more effective and efficient,” Canose said.

A good administrator

Fort Worth orthopedic surgeon Steve Brotherton, president of the Texas Medical Association, said he supports the idea of having physicians in leadership, but it’s not the be all and end all.

“If I’m talking to a hospital administrator to get something changed, I want a good administrator,” he said. “If I have a malpractice suit, I might like a doctor who became an attorney, but I really want the best lawyer,” he said.

Joel Allison, CEO of Baylor Scott & White Health, took a similar stance. The organization was created last month with the merger of Baylor Health and Temple-based Scott & White, which has been a physician-director organization since its inception in 1897.

“We look for the best and most qualified individual to take on an executive role. It could be a clinician,” Allison said, but it might also be a specialist in information systems.

“There are certainly superb hospital leaders who are not clinicians,” said Klein, the Baylor All Saints chief. His own background as a surgeon “has been beneficial for me in my relationship with my medical staff, seeing both sides of the healthcare equation,” he said. But his MBA is valuable, too.

“It just gives you a good sense of revenue and expense management. It helps with strategic planning and growth,” said Klein, who oversees a staff of about 1,800. And really, he says, “I would not have been a candidate for the position I’m in without it.”

Baylor offers a Nursing Fellowship at Southern Methodist University that aims to build business skills among clinical leaders. It’s part of a general trend of financial education for healthcare professionals, Singleton said.

“The good news is we’re seeing a renaissance in executive training for physicians,” he said. “There are several MHA (Master of Health Administration) programs for doctors,” including one of the best in the nation at Trinity University in San Antonio, he said.

Jim Fuquay, 817-390-7552

Twitter: @jimfuquay

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