Health Care Is a Team Sport

Chapter 2


HEALTH CARE IS A TEAM SPORT


Scenario


Health Care Blog, 6 Months Ago



Dear readers,


We are following up on the longstanding rumors about severe dissatisfaction, high burnout, and excessive turnover levels among physicians at University City Health (UCH) in Washington State. Finally, the state’s patient complaints unit has gone public with descriptions of poor-quality care and a number of pending lawsuits, as well as low morale among the nursing staff, that culminated with a very poor performance at a recent Joint Commission inspection. Although the results of the inspection are not yet formalized, feedback given to the UCH leadership team indicated that several major citations would be issued and extensive changes needed. It is rumored that the board is unhappy with several C-suite incumbents and may be taking action soon to replace some of these. Our understanding is that these changes will likely include at least the chief executive officer (CEO) and chief medical officer (CMO) being asked to leave. We have tried to get comments from UCH, with no success. The hospital has, however, confirmed our report last week that the nationally known UCH microvascular surgery program has been closed following its loss of accreditation for training residents, two major lawsuits, and the departure of three out of four main vascular surgeons. The situation at UCH is clearly very fluid, and we will continue to report on this.


Health Care Blog, 3 Months Ago



Dear readers,


Once again, this week we focus on the troubles at UCH. Until a few years ago, UCH was nationally recognized as a leader in inpatient care, especially in the surgical area, but now it is seemingly heading in a downward spiral toward a very uncertain future. As we reported previously, CEO Bill Jameston was fired following the dreadful Joint Commission survey, amid a slate of wider accusations of poor personnel management and nepotism involving the employment of several family members. The UCH physicians group appears to be battling internally with the leadership over what they believe has been poor resource allocation and a leadership focus on financial management over clinical care. We understand another four senior physicians have resigned in the past month and that the emergency medicine residency program may well lose its accreditation soon. The only bright spot for UCH seems to be the rapid appointment of Brian Gordon, M.D., as interim CEO. Dr. Gordon was drafted into the position via an agreement with the California UCH Hospital Group, where he has a stellar reputation, and was able to transfer rapidly to Washington State to take up the interim position for reportedly at least 1 year. Dr. Gordon is becoming somewhat of a turnaround expert, having been placed in two troubled hospitals previously, both of which he resurrected by bringing in an almost entirely new management team. We wait with anticipation to see what he does at UCH.


University City Health Administrative Offices, 1 Month Ago


Dr. Gordon, the recently appointed CEO of UCH, shook Dr. Sierra’s hand and showed her to a chair. “Thank you for attending this interview, Dr. Sierra. We really appreciate your interest in the position of CMO at University City Health. I know that you have already spent considerable time with the search firm and have had the opportunity to learn about us, just as we have learned about you. We hope this interview will be helpful for all of us and will give you the opportunity to ask further questions about the position. Before we get started, let’s go around the table and introduce ourselves.”


Dr. Sierra, a well-dressed woman in her forties, sat and listened carefully. Although the interview had not begun in earnest, she felt confident and knew she was making a good first impression on the committee. She smiled at Dr. Gordon and then carefully focused on the whole committee, five men and two women, sitting around the highly polished maple boardroom table. Dr. Sierra knew their backgrounds from her research on the UCH leadership, so as they introduced themselves, she mentally reviewed her plan for starting the interview. She had to be careful not to offend or appear disrespectful to the group. She assumed several of them were likely responsible, at least in part, for the well-publicized problems in the media and the courts that had beset UCH over the past 5 years, and that if she were successful in this job interview, some of them likely would not be retained. She thought about their roles and what she knew about them.


The chief of staff, Dr. Stone, on her immediate left, was a serious-looking, relatively young female anesthesiologist wearing her green scrubs under a lab coat. She wore little makeup, and her light brown hair was tied back. She had just been elected to this role by the UCH medical staff, and Dr. Sierra knew from her research that Dr. Stone was internally quite powerful and on a fast track to administrative promotion. Dr. Stone had been quoted frequently in the media and had led the medical staff in their publicly reported fights against the prior administration. She was quite a contrast to her predecessor, Dr. Rogers, who was seated next to her. He had appeared in the press as a frail, elderly surgeon who frequently seemed to be caught wearing wrinkled scrubs and an exhausted look. Next to him sat Dr. Riley, the director of quality, an ophthalmologist who was nearing retirement and seemed to have little role or influence at UCH. Both physicians sat looking at their interview papers rather than at her. They were quite a contrast to Dr. Gordon, the new CEO, sitting opposite her at the end of the table. He appeared friendly and engaged, eyeing her directly. She knew he was a forward-looking, rather driven endocrinologist who had been appointed to this new role after the appalling Joint Commission report and sudden resignation of the prior CEO a year before. One of Dr. Gordon’s first actions had been to fire the previous CMO, which had led to this job interview. The final physician on the panel, Dr. Burtone, was the chairperson of the department of pediatrics, a longstanding and seemingly quite successful individual heading one of the few departments that did not have major physician recruitment problems. She wore a lab coat adorned by a large, handwritten badge announcing her as “Doctor Anna.”


The other two interviewers were the nonmedical members of the panel. Mr. Carney, the director of patient care services, was another long-term staff member who had been heavily criticized in the press. The last person was the director of public relations and marketing, Ms. Odono, a new recruit who was quite successfully starting the essential process of rebranding UCH. Quite a job, Dr. Sierra thought to herself. In the weeks prior to this interview she had researched all the UCH senior leadership, and having now met her interview panel, it seemed clear that the power and decision-making capacities in this group lay mainly with the CEO and the chief of staff. She decided to focus primarily on them in her responses.


“So, Dr. Sierra, now that we’ve all been introduced, and given that the members of this committee have read your application and resume, perhaps we can begin. Would you mind telling us why you are interested in this position, and what you plan to do early on if you are appointed?” Dr. Gordon said.


“Thank you, Dr. Gordon, and thanks to all of you here for taking the time to review my application and meet with me.” Dr. Sierra looked around the group, pleased to be taking the stage at last. She spoke comfortably to the panel as a group. “I am aware from my background research of some of the difficulties that UCH has had over the past several years, more publicly so in the past year. However, as an outsider, I cannot pretend to really understand the breadth and depth of these difficulties, so please bear this in mind; I expect it will take at least a couple of months, if I am appointed, to really understand the dynamics of what has been happening. So, with that caveat, let me explain why I am here.” Dr. Sierra smiled at the group and noted that all were paying full attention to her.


“You know from my background that my main focus in recent years has been on organizational change, and how to do this in a positive manner that improves both patient outcomes and staff and physician morale. As part of my MBA1 program several years ago, I worked with the team that developed the ‘Triple Aim’ of better health for the population, better care for individuals, and cheaper costs. This triple aim was taken up widely around the country, including at UCH. In my view, however, this three-legged stool has been superseded by a four-legged chair that includes a fourth leg of clinician wellness.”


Dr. Sierra could see Dr. Gordon nodding positively, obviously aware of the important attitudinal change increasingly being adopted by hospitals and health systems around the country. She continued.



“The first thing, for me, is to ensure that all of you, and your other leadership colleagues, are aware of this important practical issue and that we adopt this quadruple aim at UCH. Why? Well, my research shows that little focus has been paid in the past on clinician well-being, especially that of physicians. This has led not only to poor physician morale, increased levels of burnout and turnover, and worsened patient care but also to poor morale among all other staff who work with your physicians. It is hardly surprising that if the main cog in a machine isn’t working properly, then the rest of the machine becomes less functional. Health care is a team sport; if the quarterback is injured, the whole team is adversely affected.”


Dr. Sierra wanted to know now where the interview panel stood on this issue; if she could expect no support for this approach, she wanted to know early so she could decide whether to go forward with her application. She decided to find out and turned toward Dr. Gordon.


“Dr. Gordon, I am aware that you have been in your role only for a few months. What do you think of endorsing and promoting the quadruple aim as a way of reinvigorating UCH and putting a real focus on the staff, especially key physicians on whom the entire system depends?”


“Thanks for bringing up this important topic so early in the interview,” Dr. Gordon responded. “I am delighted to discuss this and to endorse the approach. My only concern is that if we implement this quadruple aim, we must have solid plans in place to improve the support and morale of our physician group. There’s nothing worse than announcing a new approach but having no practical plan for implementing it. What are your ideas on that, Dr. Sierra?”


Dr. Sierra was pleased with this response, but before she could answer, Dr. Stone interrupted. She spoke excitedly.


“It is so good to be listening to this conversation! I know we haven’t spoken before, Dr. Sierra, but this is exactly the sort of approach that the medical staff, or at least those of us who are left, have been promoting! I’m so pleased you see wellness as a cornerstone of your plan, and I look forward to what you propose. You mentioned football players; I wonder if you’ve heard the metaphor about teams in health care that compares physicians with athletes in terms of their training and support needs? It was presented at a conference I attended recently. Both groups share a lot of similarities—they require many years of training, very high performance levels with few or no mistakes, continuous learning and striving for improvement, and appropriate rest and sustenance. This rest has to be physical, psychological, and social, of course, and strong support systems must be in place to help maintain or improve performance when necessary.”


Dr. Stone continued, her tone becoming reflective. “Although physicians do get many of their needs fulfilled, they tend to be very bad at asking for help if everything is not going well, so they miss out on extra coaching or the equivalent of sports psychologists when needed. They often work way too many hours with little or no rest, to the detriment of their home and social lives. And whereas athletes ultimately are measured only on whether they win or lose, physicians are measured by numerous groups—patients, colleagues, administrators, multiple data comparisons of outcomes and activity, and an increasing series of bureaucratic reporting requirements. All of these—to my mind—absurd reporting necessities put extra pressure on us and take us away from our core goal of providing great patient care, which is why we chose medicine as a career in the first place.”


Dr. Stone had been speaking passionately. Realizing that she was taking up too much time, she came to a sudden stop. “I’m sorry to get on my soapbox, Dr. Sierra, but I do wonder what you think about all this.”


Dr. Sierra smiled. The conversation was going in the direction she wanted, and she was extremely pleased with the responses of Drs. Gordon and Stone. It seemed she had at least two strong supporters for the approaches she wanted to implement at UCH. She decided to lay out some of her ideas.


“First, please don’t apologize, Dr. Stone. I agree with you about the athlete metaphor. I also am very pleased, Dr. Gordon, to hear your endorsement of the quadruple aim approach. Although the CMO position I’m applying for involves much more than supporting physicians and other providers—and I have numerous ideas for improving the administrative systems, especially around quality and credentialing—I think the immediate task we need to focus on at UCH is restoring morale and stopping the exodus of physicians. I’m sure you know that your largest competitor, West Health, has actually drawn up a list of ‘target’ UCH physicians whom they are trying to recruit.”


While other committee members nodded in affirmation, Mr. Carney, the director of patient care services, responded. “Yes, we are aware of that situation, Dr. Sierra, and we have approached them about it, but with little success. Health care is such a cutthroat business; it sometimes feels as though we are a wounded animal surrounded by vultures.”


“Sadly, you are right,” Dr. Sierra answered. “And if you don’t make rapid solid changes, the vultures may well disembowel you. If I am appointed, my first focus will be on the whole area of physician well-being, and I will need considerable support from the leadership team, as well as an appropriate budget, to implement my strategy. Having said that, I believe now is a really good time to do this. It will be a strong message to all current UCH physicians that they are respected and valued, which will, I hope, have a positive impact on morale.”


Dr. Stone enthusiastically endorsed what Dr. Sierra was saying. “I’m sure you’re right. Such a proposal will be seen as a very positive move by most of our physicians, many of whom have been here for most of their careers and are heavily invested in the academic mission of UCH. Can you give us some broad details of what you would like to do?”


“Certainly. The first component is to communicate what we wish to do and to keep communicating with all of our physicians, especially about UCH formally adopting the quadruple aim as the core of its strategic plan. I would like to create a new leadership position, probably half-time at first, that we will call the chief wellness officer, or CWO, and some sort of advisory board on physician well-being. This CWO position will be filled by an internal candidate; from what Dr. Stone says, it seems several people may be interested. He or she will need two or three analytic and communications staff and, I assume, will adopt the three-domain Stanford Wellness Framework,2 which involves creating a culture of wellness, improved efficiency of practice, and better personal resilience across UCH and the physician group. We can put some of those parameters into their job description.


“Much of the work of the CWO will depend on regular measurements and results, and I really don’t have a good handle on what UCH has done already and whether burnout or well-being have been measured here in the past. Whatever has been done, we will need to put in place some measurement processes over time and also survey the physicians about what they see as major unfilled needs or as obstructions to providing excellent clinical care. Then we have to keep communicating internally and externally, particularly highlighting excellent practices, individuals, and teams. Lots of other options and initiatives can be implemented over time, but to me, the most important aspect of this strategy is to change the culture at UCH so that clinician well-being really does become one of the core legs of the UCH quadruple aim—in fact and action, not just in name.”


As she spoke, Dr. Sierra observed the interview panel and was pleased to see positive responses from Drs. Gordon and Stone, although the other physicians in the group seemed fairly neutral. Dr. Stone caught her eye and asked the first question.


“Tell me about the ‘improved efficiency of practice’ part of this strategy. That sounds a bit like more potential pressure on our physicians, at least in the short term, if it involves yet more change. I think many of my colleagues already have what they call ‘change toxicity’ and are wary of being required to change their practices or clinical workflows again. In the past, such changes usually have been made primarily to increase the revenue base, not necessarily to improve clinical care.”


“I understand your colleagues’ concerns, Dr. Stone. Any such efficiency changes would have to be undertaken very carefully and with full consultation with all those involved. The aim is to take pressure off physicians, give them more time with patients and have them spend less time on administrative tasks and documentation, especially the EMR.3 You’ve probably heard of one recent article that described how to get rid of what was called ‘stupid stuff,’ defined as anything in the EMR that was badly designed or unnecessary?”


Several people nodded.


“Let me give you one other quick example of potential changes,” she continued. “Do you think that American doctors practice medicine very differently from their European counterparts?”


“No,” answered Dr. Stone. “I spent a month in Paris as a resident on an elective and was surprised at how similar the quality of medicine was. In fact, in some areas, such as infectious diseases, the French are way ahead of us.”


“So, if their practice standards are similar, would you assume that they write approximately the same number of notes per patient?”


Dr. Stone considered the question. “Probably not. I suspect that U.S. doctors actually write somewhat more notes, because we tend to practice more defensively and are more frequently being sued, and we have some ridiculous requirements for billing. So maybe American doctors might write—as a guess—up to twice as much as European doctors? But I’d be surprised if it was really that much extra.”


“Well, you would be wrong,” replied Dr. Sierra. “A recent comparison of European and American medical notes showed that U.S. doctors actually write between three and five times as much as European doctors, and for no obvious clinical benefit. Can you imagine how much extra time that takes away from patient care, and how much extra ‘pajama time’ our physicians spend after hours and on weekends working on their notes as a result? It’s awful! One of the areas I would look at is excess documentation. For this, it would be necessary to work with both payers and physicians to educate everyone about this issue and start allowing physicians to write less—while still writing good clinical notes. A massive amount of time could be saved here, and not just by the physicians who are writing the notes. I’m sure you’ve read many notes where patients are seen each month and a long note is often copied and pasted into the record with very few changes. When you see this patient, perhaps for the first time, you have to read through ridiculous volumes of repetitive notes to find comments about changing clinical status. Wouldn’t it be so much simpler to have one initial comprehensive note and then multiple follow-up notes that identify only important clinical issues? You could review the notes in half the time and be much less likely to miss important clinical changes. Think of the average wiki and imagine that as a constantly updated patient medical record.”


Dr. Gordon looked up from the file in front of him. “Huh. That is really amazing, when you think of it like that. I didn’t realize these data were so compelling. Thank you for telling us. The potential time savings would be huge for both the doctors who are writing and those who are reviewing the notes. That would mean more time with patients and likely less burnout and dissatisfaction.”


The interview continued for another half an hour, with questions from all members of the panel all expertly fielded by Dr. Sierra. By the end of the agreed time, the atmosphere in the room was friendly and collegial, and the interview had morphed into what appeared to be a friendly discussion among colleagues rather than a high-stakes meeting. Dr. Sierra, however, although inwardly confident about her performance and her qualifications for the CMO position, knew that she had one last enormous fence to jump if she were to be appointed, a fence she had failed to jump several times already in interviews for similar positions. She knew the only way to handle it was head on during the interview.


When Dr. Gordon moved to finish up the interview and asked if she had any further questions or comments to make, she surprised everyone by asking to tell a story about herself for them to consider. She looked around the panel and then deliberately focused on Dr. Stone, whom she believed likely to be most sympathetic. Dr. Sierra started speaking directly to her, trying to follow the advice of her psychiatrist to forget that she was in a high-stakes interview and to imagine she was telling her story to a compassionate colleague in a coffee shop.



“I hope it’s clear that I have the academic and professional experience to successfully become your CMO. However, I need to tell you about one issue that you will find in my credentialing papers if you decide to consider appointing me to this position. I would rather tell you about this myself, here at the interview, so you can hear my side of the story directly rather than just assume that the papers and decisions from the medical board are correct and fair. I will be quick with my story, and I thank you for listening to me.”


The interview panel, who previously had been winding down and starting to relax at the end of what they all thought was a most impressive interview, suddenly became more alert at this unusual finale. Dr. Gordon, in particular, was mystified and concerned, because he had been particularly impressed by Dr. Sierra and felt confident that he had found a first-class CMO with whom he could work well. He especially liked her interest in physician well-being and her impressive, thoroughly considered strategies to improve physician morale and retention. He watched her and listened intently, with no idea where Dr. Sierra was going with this unusual closing statement.


“I went into medicine because I wanted to help people, and that is still my passion,” Dr. Sierra began. “Unfortunately, my family includes several people who have been depressed, including my grandmother, who raised me after my mother died from suicide a month after I was born. My own first bout of depression occurred in medical school, and since then I have had five serious episodes, only one of which led to me taking any time off work when I was a junior attending about 12 years ago. At that time, I was given very bad advice by a senior colleague; I was advised to voluntarily tell the medical board about my depression and that it was why, on the advice of my psychiatrist at the time, I was taking a month off work. Since then, I have been in a battle with the medical board, although I did not employ lawyers until about 7 years ago when they tried to take away my medical license completely. I have never been impaired to practice; have never been psychotic or so ill that I was dangerous to myself or others; have never been certified or admitted to a psychiatric hospital; have never tried to kill myself; and have never had a drug or alcohol problem. I have sought help and have a regular psychiatrist and psychotherapist, and I take long-term medications that have helped me greatly. I have not had to take time off work because of depression in the past 12 years.”


Dr. Sierra sat back, still looking intently at Dr. Stone but also carefully scanning the rest of the interview panel for their reaction. Would they suddenly think of her very differently? She decided to continue her story without giving them a chance to interrupt.



“What I have discovered, however, is a horrendous level of bias and stigma against doctors who are labeled as mentally ill, and how this pervades the licensing system and some of the staff that they employ, as well as other hospital credentialing groups. Immediately after I shared my story with the board, I was forced to stop practicing for 3 months until I could prove to one of the medical board investigators, a nonclinician, that I was fit to work again—despite my own psychiatrist giving me a return-to-work fitness note after 4 weeks. I was required to go into a supervised practice program and to do random alcohol and drug tests for 3 years, despite never having had such a problem, because apparently they considered me at risk for self-medicating with alcohol because of my depression. If you look at my license on the medical board website, it will say that it is unrestricted, now that I have gotten lawyers involved, but it also shows a long history of licensing restrictions that I cannot get removed and that are there for anyone to read. My whole professional life has been turned upside down by this situation, and I have been turned down for a number of jobs as a result, despite my excellent qualifications and references.”


Dr. Stone looked very compassionately toward Dr. Sierra, clearly touched by this story. She was aware of how difficult it must have been for Dr. Sierra to bring it up at the interview and to be so open about her situation. She knew several of her colleagues were likely to treat this background information as a fatal flaw, and she wanted to give Dr. Sierra the opportunity to present herself as well as possible.


“I really appreciate you being so direct about this situation, Dr. Sierra,” she said. “It cannot be easy to address such a personal issue, and one with such unfortunate and apparently long-term professional consequences. Thank you. I wonder if you could confirm with us, as you have brought it up at the interview, what your health status currently is, and whether you have any outstanding licensing or credentialing issues that we need to know about.”


“Thank you, Dr. Stone. I appreciate your kind comments. This is not an easy situation for me, nor for you, I am sure. I’ve learned that it’s best to be completely up front about my past rather than wait for you to discover it when you run my background check, if you decide I am a potentially appointable candidate. I would rather be completely honest from the beginning of any professional relationship, and I am particularly keen to be appointed to UCH, because I see so much that is positive here. My psychiatrist, whom I have seen for about 8 years now, tells me she thinks I am so enthused about this job because of some unconscious parallels I am drawing between UCH and myself, but I’m not sure about that. She thinks I want to help turn UCH around, just as I have turned myself around, because she knows there are many excellent physicians at UCH who have done nothing wrong, just as I did nothing wrong by reporting my illness to the medical board. Anyway, whatever the case, what I can do is assure you that I now have a full, unrestricted medical license after 7 years of legal fighting and considerable expense.


“I also know that I have a diagnosis of recurrent major depressive disorder with a likely strong genetic component and that I am well and have a strong therapeutic team in place to help me with any future relapses. As a result, I should neither need to take time off work nor have any level of medical impairment. I have no other medical illnesses, and my depressive disorder has overall caused me to have much less disability or loss of work time than if I had diabetes, arthritis, or cardiac problems. I’m not sure if you have any questions you would like to put to me now, but I welcome these if you have. Whatever your reaction to my story, I hope you will bear what I have said in mind as you make your decisions and if you feel you need to review the various documents about me on the medical board website.”


Dr. Sierra sat back, satisfied that she had given a reasonable description of her difficulties and pleased that she had remained objective and had not been excessively defensive in her self-description. She flicked her head sideways, brushed aside some stray hairs that had fallen over her left eye, and surveyed the room. She was uncertain as to the panel’s response, although she noted sympathetic smiles from several members. She turned toward Dr. Gordon and waited for his comments, because she knew that her time with the panel was now well over. He thanked her for her honesty and preparedness to openly discuss an obviously very painful but important sequence of events. After receiving his additional thanks for attending the interview, Dr. Sierra left the room.


Dr. Gordon turned to his colleagues and initiated an immediate discussion about her. “I would like to hear what you all thought of Dr. Sierra, and whether you think she is appointable as our CMO. As you all know, she was our top choice on paper and has considerably more experience than any of the other candidates we have reviewed. Like all of you, I suspect, I was not aware of her past licensing situation or of her longstanding mental illness, and I think we certainly have to take those issues into account as we make our decision about whether to appoint her. I seek all of your opinions and expect that they will inform mine. Who would like to go first?”


Rather to Dr. Gordon’s surprise, the first three speakers were the surgeon, the ophthalmologist, and the director of patient care services, who between them had contributed least to the interview so far. They all spoke positively about Dr. Sierra’s qualifications overall but made it clear they thought that appointing her would be too great a risk for UCH. Their concerns were broadly twofold. First, they thought that UCH would be further criticized in the press if it became widely known that the new CMO had had a lot of medical licensing problems, and that these problems might impair her relationship with the medical board. They argued that this could be a challenge in her role as CMO, where she was inevitably going to have regular interactions with the board about other UCH doctors and would need to have a good working relationship with them. Second, they were concerned that she had what they described as a chronic mental illness, which they felt might impair her judgment in the future and made her unfit, in their opinion, to hold a C-suite position.


Dr. Gordon listened patiently to all three and deliberately asked the director of marketing, Julie Odono, for her comments next. Dr. Gordon had come to rely on Ms. Odono for her rapid and accurate assessments of individuals whom she met and for her direct and honest feedback to him if she thought he was making an error in judgment. She did not surprise him when she immediately took a very different view from the previous speakers.


“I have to say that I totally disagree with what the others have been saying. I thought she was superb, and I would love to work with her. From my perspective in marketing, she is someone whom I believe will represent UCH excellently, and I cannot wait to get her in front of the media. She will be able to defend herself, I’m sure. Having said that, we obviously have to do some due diligence about her licensing issues and review what has occurred, but I believe her. I’ve seen other physicians run into similar problems with medical boards, and also with some physician health programs, and I’m sure that if you Googled it, you would find quite a few similar anecdotal experiences. I’m not trying to be critical of medical boards, who have a hard job, but their primary purpose is to protect the consumer, not the doctor. Undoubtedly, in some situations they have to make decisions based on their requirements that can place undue burdens on physicians from our perspective. I would be happy to help investigate this situation, and that may even involve further discussions with Dr. Sierra herself. Let’s not rush to judgment on the licensing issue. I give her kudos for bringing it up herself in such an important interview.


“On the issue of her having a mental illness, I am just surprised that you three intelligent health professionals take the view you do. If we were to ban all people with such disorders from C-suites around the country, we would lose many of our best business and health leaders. These illnesses are very common, and as a health system we should take the lead and never discriminate against those who have them, as long as they are not impaired. And no evidence that she has ever been impaired has been reported, from what I heard.”


Dr. Burtone, the chief of pediatrics, spoke next in her usual careful, measured tone.


“I have to say that I agree with Julie completely. I thought Dr. Sierra was a breath of fresh air, and someone whom we really need. I liked her personally and would feel very comfortable reporting to her, and I believe my other chair colleagues will as well. I thought she had a very strong side to her, almost steely, especially in the way that she has overcome obstacles. To have completed her MBA and to have such stellar references at a time when she was fighting for her professional life with the medical board and getting a handle on her own depression is simply amazing. I agree that we have to do our due diligence about the licensing issue, but I think she is just the sort of person to help lead UCH out of its dreadful mess. And from what I understand, her husband is also an excellent surgeon; if we get her, we might also recruit him, which is an excellent add-on bonus—although I know we are not meant to take note of such situations during her recruitment.”


“Thanks indeed, Dr. Burtone. I really appreciate your comments. You’re right; if we can recruit her, we may also be recruiting part of a real power couple who could help draw other talent to UCH,” said Dr. Gordon. “Over to you, Dr. Stone, although I suspect I know in which direction you are likely to move.”


“I think you do, Dr. Gordon. I must have made my attitude toward Dr. Sierra fairly obvious during the interview. Clearly, I agree with Julie and Anna, and I would welcome Dr. Sierra with open arms, assuming that our review of her licensing situation comes out okay. I think she has a very strong professional and administrative background and a good clinical reputation, and she has even written a number of interesting papers on the topic of physician well-being, on which she seems to be quite an expert. We now know part of her motivation for that interest, but it is an interest that suits UCH perfectly, and I really liked her strategic ideas for how to improve our physician morale and efficiency of practice. I thought it was very gutsy of her to bring up this issue so overtly in this interview, even before we have gone down the path of checking her credentials. Others would have waited to find out if they were a preferred candidate and only then would have revealed their background, so she certainly took a risk by being so open with us. But I like that! We need someone who is confident enough to take a risk on themselves. I would totally support her appointment and would be happy to recommend this to the medical staff executive committee if you wish.”


“Thanks indeed, Dr. Stone. I like the way you think, and your openness about her,” said Dr. Gordon. “It seems that we have two sets of strongly held views about Dr. Sierra, and I appreciate all of you giving me your honest opinions.” He paused and looked around the panel, seemingly asserting himself and coming to a conclusion. “When I am selecting someone who will be reporting directly to me, I have long believed that one factor is of greater importance than all others, assuming that the individual is qualified for the position, as Dr. Sierra certainly is. That factor is trust. Do I trust the individual? Will they, to use a political phrase, speak truth to power, and will they always be dependable and someone on whom I can rely? In Dr. Sierra, I think we have found just such a person, and I think she showed us that side of herself today in an unusually brave, and—to use Dr. Stone’s word—gutsy performance. So, although I will arrange for her licensing situation to be checked out, I do hope you will all support her being offered the position and will keep the conversation we’ve had with her this afternoon completely confidential. The confidentiality is for both her sake and ours. Thanks to all of you for putting in so much time and effort on this search. I will follow up with Dr. Sierra and see what we can negotiate with her. I have a good feeling about this and really hope we can add her to our team.”


Health Care Blog, Present Day



Dear readers,


Is UCH continuing to stumble? Readers will recall the massive problems the hospital has had over the past year with its physicians and the drain of their physician talent to other health systems. Well, UCH has just announced the appointment of Dr. Roseanne Sierra as its new chief medical officer. Dr. Sierra has an excellent academic and business background, so why do I ask if UCH is stumbling again? Well, I suggest you look at Dr. Sierra’s background on the medical board website. She was put on probation many years ago after a self-reported psychiatric illness and has been engaged in litigation for several years to clear her name and obtain an unrestricted medical license. Is this really the sort of doctor UCH should be employing to lead its physician practice group? The CEO of UCH, Dr. Gordon, strongly defended Dr. Sierra when asked about her background and said that he looked forward to working with her and did not consider her past history of depression a significant concern. He said that he admired her strength in successfully fighting the medical board to clear her name, and he predicted that she would show similar leadership qualities in her work with UCH. We hope he is right, dear reader, and will be following up closely as she begins her work next month. UCH cannot afford any more stumbles!

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Mar 29, 2020 | Posted by in PSYCHIATRY | Comments Off on Health Care Is a Team Sport

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