Pediatric hospitalist Jeff Sperring, MD, says he did not go into medicine with aspirations of becoming a hospital administrator. Last November, however, he was named president and CEO of Riley Hospital for Children at Indiana University Health in Indianapolis. It’s a path into healthcare leadership, he believes, that other pediatric hospitalists can and will follow.
“Being a hospitalist was critical to that progression. You are there; you understand what needs to be changed. More than anything else, it’s just being available, willing, and able to help,” Dr. Sperring says. “You lead one project, that leads to additional roles, and that leads to this.”
Dr. Sperring is one of a handful of pediatric hospitalists who have joined the C-suite and assumed major administrative responsibilities in their hospitals. Most say their HM experience was crucial to the journey.
Another pediatric hospitalist, Patrick Conway, MD, MSc, SFHM, earlier this year was named chief medical officer for the Centers for Medicare & Medicaid Services (see “Pediatric Hospitalist Takes CMS Leadership Position,” June 2011, p. 28), and is responsible for administering federal healthcare quality initiatives and setting the government’s quality agenda. Dr. Conway, previously director of hospital medicine at Cincinnati Children’s Hospital Medical Center, says that pediatric HM, in particular, lines up with major priorities in healthcare reform—most notably patient-centered care.
“Pediatricians often have strong communication skills honed by taking care of patients and their families,” Dr. Conway says. “Our training typically emphasizes team-based care and improving the health system.”
The path to hospital leadership might be a little different from the pediatric side. But he urges pediatric hospitalists to look for opportunities beyond pediatrics, within the larger healthcare system and the care of adult patients.
“I am an example of the potential for pediatric hospitalists to take on broader leadership roles,” Dr. Conway says. “I encourage medical students to consider pediatric hospital medicine, with its opportunities for leading change and taking care of patients at the same time.”
Leaders on the path to such C-suite positions as chief executive office (CEO), chief operating officer (COO), chief medical officer (CMO), or chief quality officer (CQO) stress the importance of finding mentors, both within and outside of the hospital, and creating effective teams in which to work. Whether a degree in business or a related field is an essential part of that journey is debatable. Dr. Sperring, for example, did not pursue formal business training, instead concentrating on leadership development. He took a one-year, part-time, multidisciplinary course on the subject offered by Indiana University. “To me, this is about understanding healthcare, how it is delivered, and then having the leadership skills to be able to make change,” he explains.
HM, with its bird’s-eye view of hospital processes and systems, is a good place to start, adds Paul Hain, MD, associate chief of staff and medical director for performance management and improvement at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn. “I also think you have to understand quality improvement and be willing to measure, measure, measure.”
But advancing up the hospital’s organization chart requires something more, he notes. “A leader also needs to have a world view that things that are broken need to be fixed,” he says.
Dr. Hain studied engineering in college and worked as an engineer before attending medical school. That experience, he says, laid the foundation for “thinking about processes in healthcare systems, and the use of statistics to help understand those processes.”
—Jeff Sperring, MD, hospitalist, president, CEO, Riley Hospital for Children at Indiana University Health, Indianapolis
For Dr. Sperring, advancement to the C-suite was a journey that began nine years ago, following four years in community-based practice. “I absolutely loved the relationships with my kids and families, but I missed the acute-care role,” he says.
In 2002, Riley Hospital recruited him to help start its pediatric hospitalist program. As the program grew to include 22 hospitalists at four affiliated hospitals, his responsibilities also grew to associate chief medical officer in 2007 and chief medical officer in 2009. Along the way, he worked on partnering with pediatricians in the community, spearheaded a quality program that successfully reduced length of stay in the hospital, and developed an integrated call center for hospital admissions across the health system.
By contrast, Steve Narang, MD, CMO of Banner Health System’s pediatric services and its new Cardon Children’s Medical Center in Mesa, Ariz., says he always had one eye on healthcare system and policy issues, even during residency.
“What clearly became the center of my work is the value equation,” he says. “I wanted to be in a career where I could impact on delivering and disseminating best practices in medical care. I wanted to find out what are the best approaches for taking care of patients.”
After residency, Dr. Narang moved to New Orleans in 2000, where he started an academic pediatric hospitalist program at Louisiana State University Medical Center. He later helped launch a firm called Pediatric Hospitalists Louisiana, which collaborated with hospitals across the state to improve pediatric care delivery. “That got me thinking about things more from the management perspective, how to fix gaps in the system and advance our ability to measure quality in pediatric hospital medicine,” he says.
“When you take your first job in the hospital and you start trying to define and design best practices, people look at you differently—not as a young, emerging physician but more as a physician leader. They come to you and say: ‘Will you chair this committee, or lead that effort?’” he says. “And then, suddenly, you run out of tools in your toolbox. That’s what happened to me.”
He enrolled at Harvard University in pursuit of a business degree, along the way learning new ways of looking at systems change and basic principles of financing.
Retain a Clinical Presence
“The great thing about being a hospitalist is that you’re at the intersection of everything that happens in the hospital,” Dr. Narang says. As the pediatric chief medical officer for Banner Health, he is responsible for strategic planning, quality improvement (QI), and patient safety for a 210-bed hospital. He also co-chairs the Clinical Consensus Group, which represents all of Banner’s 23 hospitals, where he is able to influence care processes at the other hospitals as well.
Many hospitalist leaders eventually confront the dilemma of whether growing administrative responsibilities stand in the way of a continuing clinical practice. Dr. Narang moonlights some evenings and weekends on hospitalist and emergency medicine shifts. However, despite still wanting to see patients, he wonders if he has reached the point where growing administrative responsibilities will make that impossible.
“It was a challenge when I became CMO to squeeze in clinical responsibilities,” Dr. Narang says. “But I believed that in order to be the right kind of CMO, I still needed to practice medicine … to know what’s happening on the floor and what still needs to be fixed. You also want your colleagues to see you as a credible physician.”
He hopes to maintain some clinical practice, and says hospitalists have the advantage of blocking out scheduled times on service.
Dr. Sperring says it is “an exciting time” to be a hospitalist. “The way we’re used to defining care is going to change dramatically. Hospitalists will play a key role, both in direct care delivery but also in leadership,” he says. “I don’t think hospitalists have a choice but to lead change. It becomes part of our value proposition and a competency for all hospitalists.”
Dr. Hain often is asked by other hospitalists how to get started with quality initiatives that might lead to something more. “I always say the first one is free, in order to show that you can solve a quality problem while being a full-time clinician,” he explains. “It says to administrators that you’re someone who can deliver, and that starts you on your way. There’s always something to be done to improve quality in the hospital.”
Larry Beresford is a freelance writer based in Oakland, Calif.