Flagstaff Medical Center: Steven Lewis, MD, CMO and SVP

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With most physicians being independently employed, communication between the medical staff and administrative staff is essential to the functioning of any facility. Steven Lewis, MD, chief medical officer and senior vice president of Flagstaff Medical Center, has spent the past three years working to manage the interests of medical staff in a hospital environment.

“The chief medical officer is a broad spectrum role focused on clinical care, primarily on the physicians’ contribution to that care, but also working closely with nursing leadership and helping to ensure the community needs are met on clinical basis as best we can,” Dr. Lewis said.

Flagstaff is a 272-bed, tertiary care facility that serves a large geographic area, including many rural communities in Arizona, and a diverse population, including many Native Americans. The hospital has a full spectrum of support services, with a Level 1 Trauma Center certified by the state of Arizona, a 30-bed intensive care unit, a pediatric intensive care unit and a robotic surgical program. Dr. Lewis estimated that Flagstaff will see about 45,000 patients in the emergency room this year. The hospital’s bariatric surgery is designated as a Center of Excellence.

Flagstaff is working on initiatives to improve quality and provide more services to patients in its community. In March 2010, the hospital opened a technologically advanced cardiac catheterization lab, providing minimally invasive procedures and advanced imaging.

Bridging the gap between medical staff and the board of directors

To adequately support these endeavors and others, support from the medical staff is critical. As chief medical officer, Dr. Lewis says the key to success is “knowing how to communicate.”

“You have to understand the nature of the relationship between medical staff members as individuals and as part of an organization,” he said. “In my role I work closely with the medical staff, helping the medical staff organization and individual members work on quality measures to improve the level of care we provide on continuous basis.”

The hospital has been working hard to reduce surgical site infection rates.

“Our current rates are all within expected norms, but we decided that we wished to improve beyond that, and we initiated some extensive process evaluations and changes,” he said. “We’ve seen continued improvement and have begun working on more quality measures.”

In addition to working with the medical staff, Dr. Lewis is also accountable to the Board of Directors. “Another factor in being successful in my role is learning how to be a meaningful member of an administrative team,” he said.

He reports regularly to the board on all quality measures, clinical staff issues, and patient satisfaction with the facility’s clinical care, while being the representative from the senior management team.

Bringing all these aspects together into one role is difficult, and Dr. Lewis continues to stress communication as key. One test of this role recently has been the implementation of computerized physician order entry (CPOE) at Flagstaff. Dr. Lewis was at the forefront of managing physician concerns with this change: Why should I do this? How does this impact my productivity? How does it improve patient care?

“In this situation, the first step is understanding that the project can go no faster than the medical staff is willing to accept it,” he said. “We created interdisciplinary leadership of both administration and medical staff. Over about three or four months, teams were more in tune with each other’s needs – not necessarily in agreement, but more understanding. For the next three to five months they developed joint plans.”

Dr. Lewis said the stakeholders have reached a point where they recognize each other’s needs and differences and agree to find a way to implement CPOE in the best way possible. “That’s been about a seven-month evolution.”

Challenges to leading medical staff

One of the challenges Dr. Lewis faces, that is common to many hospitals, is employed physicians versus independent physicians. Flagstaff has a small number of employed physicians, including all hospitalists, two cardiologists and some other specialists to fill community needs. Dr. Lewis said the hospital has been transparent about why it has used the “employment vehicle” and openly discusses plans for additional employed physicians with the medical staff.

“We address why we choose to employ some physicians in a regular, open fashion,” he said. “We are making some progress. Our hospitalist function has become a part of how we do things here, and the medical staff has become comfortable with that arrangement.”

Dr. Lewis is pleased overall with the success Flagstaff has had in bringing together the various interests within the health system.

“I think in this environment the working relationship between the hospital and medical staff is critical and is going to become more critical. I believe it’s safe to say this organization and the medical staff have made a lot of ground in working together, to plan together, to lay ground together,” he said. “That doesn’t mean it’s smooth or all issues are agreed upon by both parties, but at least the foundation exists.”

-by Patricia Chaney

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