• Engaging Physicians in Strategic Decision Making

    By Laura Ramos Hegwer Nov 05, 2018

    Physicians at an independent community hospital in Missouri are helping ensure a successful integration with a recently acquired hospital while also contributing to other strategic initiatives.

    Physicians play an essential role in guiding the direction of St. Luke’s Hospital, the only independent, not-for-profit hospital in the western St. Louis market. The medical staff at the Chesterfield, Mo.-based community hospital includes 750 employed and independent physicians as well as 40 medical residents. In recent years, many physicians—both employed and independent—have become more interested in helping lead the organization.

    Physician_Candio“I realized when I got here four years ago that I needed to create a forum with my physician leaders to be a sounding board,” says Christine Candio (pictured at right), president and CEO. Because the hospital does not have a chief medical officer or vice president of medical affairs, Candio created a cabinet of physician leaders to help advise her. She worked with her chief of medicine, Maged Haikal, MD, to create the cabinet, which includes all of the hospital’s chiefs of services, the chairman of St. Luke’s Heart and Vascular Institute, and the president of the medical staff. She meets quarterly with these physician leaders to discuss the hospital’s strategic efforts, including its first acquisition.

    Ensuring Integration Success

    On April 30, 2018, St. Luke’s Hospital completed the acquisition of a 143-bed hospital in Des Peres, Mo., from Dallas-based Tenet Healthcare Corporation. When Candio was first considering the acquisition, she sought feedback from Haikal on how the medical staff might feel about the deal. She also solicited the opinions of physician leaders on the hospital’s board of directors. “Obviously, we had to have a tight circle because it was a very confidential process,” she says. “But I felt very comfortable having the voice of the medical staff represented.”

    Now that the formal acquisition is complete, Candio has asked physicians to join integration teams, which have specific focus areas. For example, a team that includes key physicians is helping integrate a bariatric surgery program at Des Peres Hospital with a nonsurgical weight management program at St. Luke’s Hospital. Physicians also are working on a team to standardize protocols and quality dashboards at both hospitals. 

    Engaging the Medical Group

    Candio also has created opportunities for the hospital’s medical group to become more connected to hospital leadership. The medical group has existed since 2005 but lacked cohesion until recently, Candio says. About a year ago, leaders at St. Luke’s Hospital created a physician steering committee to develop a mission and vision as well as a new leadership model for the medical group.

    Today, a medical director and a vice president jointly lead the group under a dyad leadership model. Together, they help facilitate the medical group’s physician advisory council, which includes 12 appointed physicians from a variety of specialties and an advanced nurse practitioner. The council also includes the medical director in charge of population health and care coordination. 

    Council members, who have term limits and prescribed responsibilities, are organized into committees covering areas such as informatics, branding, and quality. Each month, the advisory council convenes for a dinner meeting that follows a structured agenda. The only nonphysicians present are the medical group’s vice president, the administrative director of the hospital’s population health and care coordination division, the hospital’s executive vice president and CFO, and Candio.

    Including Physicians in Capital Decisions

    To ensure that physicians are actively involved in capital decisions, the hospital’s capital committee is chaired by a physician and includes a cross-section of specialists as well as administrators. “They have very healthy discussions, physicians to physicians, on why they need [a piece of equipment],” Candio says. “They also gain a great understanding of areas other than their own, and they actually negotiate.” In some cases, physicians agree to put their requests on hold until the next fiscal year if they believe that a colleague’s capital needs are more important to the hospital’s mission.

    At the end of the process, the hospital has a “negotiated, agreed-upon list of capital expenditures driven by physicians,” Candio says. “I think it’s a best practice.”

    Promoting Leadership Development

    “An important part of an organization’s mission is growing the leadership abilities of physicians,” Candio says. Soon after she came aboard, she helped create the hospital’s first physician leadership institute. Hospital leaders invite formal and informal physician leaders as well as “up-and-comers” to participate in the institute, which offers a five-class course per year. 

    Physicians meet on Saturdays and learn about the state of the industry, healthcare finance, effective communication and leadership, quality and the consumer experience, and physician leadership during challenging times. Faculty include internal as well as external experts who can provide a broad view of the healthcare industry.

    After completing the program, physicians are invited to participate in a master’s series three times a year that provides thought leadership on the hospital’s strategic initiatives. 

    Expert Advice

    Candio offers these suggestions for physician leaders on partnering with CEOs and other administrative leaders.

    Offer feedback. After the hospital launched its physician leadership institute, physicians used focus groups and surveys to provide suggestions on improving the education. 

    Request transparency. Candio shares profitability data by service line with her cabinet of physician leaders. The organization’s financial information also is dissected during the healthcare finance course that is part of the physician leadership institute.

    Invite administrators to see you work. Candio often accepts invitations to view her surgical colleagues in the operating room, an opportunity that promotes better understanding of their needs and work flow.

    Acknowledge that you can use help. “Physicians can look to administrators when dealing with issues of conflict resolution,” Candio says, adding that administrators also view partnering with physicians as a learning opportunity.

    Looking Ahead

    In addition to their ongoing integration with Des Peres Hospital, leaders at St. Luke’s Hospital are making plans to build the hospital’s first freestanding ambulatory surgery center. The center is scheduled to open during the last quarter of 2019.

    Physicians and hospital leaders are collaborating on strategies for the new facility. “We cannot be successful if we don’t truly partner with physicians and align our goals,” Candio says.


    Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill.

    Quoted in this article: Christine Candio, FACHE, president and CEO, St. Luke’s Hospital, Chesterfield, Mo.

    This article is based in part on a presentation at the 2018 ACHE Congress in Chicago.

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