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Viewpoints from the Executive Suite and the Bedside


Like many family medicine practices, Chris Heck, MD’s, group in Waynesboro, Va., made the tough decision two years ago to limit their practice to outpatient services. According to Dr. Heck, one partner, Tom McNamara, DO, MMM, CPE, was reluctant to give up hospital work.

So, maybe it’s not surprising Dr. McNamara now fills a unique dual role, as president and chief executive officer and a working hospitalist at Carilion Stonewall Jackson Hospital in Lexington, Va. Dr. McNamara is the first physician CEO at Stonewall Jackson, and the first doctor of osteopathic medicine CEO at one of the hospitals in the Carilion Clinic, a Virginia-based multispecialty organization with more than 400 doctors and eight hospitals.

Serving double duty as CEO and a hospitalist at a critical-access, 25-bed hospital seems to suit Dr. McNamara. “It has allowed me to quickly and thoroughly learn about our staff and our patients,” he says. “And it has given me insight into quality, cost, and feedback programs from both sides, so that I can make informed decisions.”

Both Perspectives

When Dr. McNamara first agreed to be CEO and work shifts, he feared he might have difficulty considering doctors’ requests impartially, or that physicians might feel uneasy working with their boss during patient encounters.

Neither fear has panned out. He says the physicians and recruits he works with generally feel they have an advocate in the executive suite. In addition, when they come to him with suggestions and requests, “they bring very thorough arguments because they know I know exactly where they’re coming from,” he adds.

Dr. McNamara already has put this unique perspective to use several times since taking the jobs in April. For example, when he started the staff was experiencing glitches when filing lab reports in patients’ electronic health records. “They were changing the process when I came in, but since I had broad experiences,” he says, “I was able to help make the changes smoother.”

Dr. McNamara also improved the hospital’s hand-washing practices by having dispensers placed in hallways, where their use could be more readily observed. The idea was to increase documentation of hand washing. “I had this thought because I had used the dispensers [at another hospital] myself,” he says.

Dr. McNamara’s hands-on experience also has made the hospitalist recruiting process easier, according to Howard Graman, MD, medical director of Carilion. “[Dr. McNamara] knows the profile of the job and the kind of person who would like it,” Dr. Graman says. “He’s a savvy judge of character.”

What Hospitalists Should Ask Executives

With his viewpoints from the executive suite and the patient floor, Dr. McNamara believes hospitalists should ask the following questions of their hospital’s executives:

1) How do hospitalists communicate with referring, office-based physicians? What technology do you use to enhance their communication?

2) Does the hospital value its relationship with the community it is located in? What activities and staff facilitate the relationship?

3) Describe what programs the hospital uses to ensure maximum reimbursement, cost-efficiency and safety. Are any of the programs tied to compensation?

4) What are the tactics for recruiting subspecialists and is there a process through which hospitalists can suggest specialists?

Double-Duty Accolades

Dr. McNamara’s bosses are happy with how he has handled the juggling act, so far. Dr. Graman says Dr. McNamara has helped him to better understand the institution, how to make improvements, and how to respond to staff. “It’s great for employees to see the head of the hospital working,” he says.

The man Dr. McNamara replaced, Steve Arner, now vice president of cardiac and vascular services for a larger Carilion hospital, agrees there are advantages to having the hospital’s CEO also be a working physician. “On the floor or in the emergency department, [Tom] can test the processes, especially new ones,” Arner says, “and see first hand the impact on practitioners and patients.”

Dr. McNamara peers think he’s effective in both of his roles. “As CEO, Tom may touch a dozen topics in a given day,” Arner says. “The boiler breaks, he does a community lecture, talks to unhappy cafeteria workers. It’s so many different things.” Because Dr. McNamara is a working physician, his words greatly affect the groups he lectures. “The fact that he is still treating patients builds confidence, especially in a small community, that the hospital is a high-quality institution,” Dr. Arner adds.

Even the nursing department is in Dr. McNamara’s corner. Shelia Hatmaker, Stonewall Jackson’s director of nursing for more than two years, appreciates the fact Dr. McNamara respects the role of nurses and understands how to address nurse-specific issues. “Tom values the partnership with nurses who are with the patients all day,” Hatmaker says. “He is my boss, but he respects and seeks out opinions from a nursing point of view.”

As CEO, “Tom can create an environment where the staff feels safe to practice and speak up when something is wrong,” she says. “They have to feel comfortable saying they almost made a mistake, because it’s often the system that needs changing.”

Agent of Change

Those system changes are now Dr. McNamara’s problem, but he’s well prepared, having earned a master’s degree in medical management from Carnegie Mellon University in 2006, 19 years after finishing his residency in family practice at McKeesport Hospital in Pennsylvania, and receiving certifications from the American College of Physician Executives.

Nevertheless, Dr. McNamara had serious reservations about leaving clinical medicine. “Clinical medicine is why I became a doctor in the first place,” he says.

Working as a hospitalist and serving as the hospital’s chief executive allows Dr. McNamara to provide patient care and lead at the same time, setting an example for admission-time standards, physician-to-physician communication, and relationships with specialists, nurses, and ancillary staff, says Dennis Means, MD, also a member of the Carilion management team. From a practical point of view, it also gives the regularly rotating doctors a break. Dr. McNamara works weekend shifts every few weeks.

Still, the new CEO has more than patient care to consider. “I’ve really been struck by how high costs are and how much reimbursements are being cut back,” he says. “I was always aware of cost issues, but now I have to figure out the best way to use our scarce resources. It doesn’t change what I do for patients, but I’m even more aware that money is very tight and I have to recognize that we can’t meet every need.”

It helps to be part of the larger Carilion system, as Stonewall Jackson is in the process of integrating with the other Carilion facilities. “We are a very small facility providing basic services, but we can tap into the capabilities of much larger Carilion institutions and people to serve this community,” Dr. McNamara says.

Hatmaker, the nursing director, isn’t surprised to hear that’s how Dr. McNamara the new CEO feels. “That’s Tom,” she says. “He wants to take care of this community. And the patients just might have the head of the hospital as their doctor. How cool.” TH

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