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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.
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.
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
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.
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.
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.
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,
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.
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
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.
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
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
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
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
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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