Hospital Impact: Chief clinical officer rises to the top, looks sideways

The CEO of a growing health system recently contacted me about recruiting a new chief medical officer. The system needed an experienced physician executive to expertly guide and engage the system’s doctors and clinical staff, champion quality, foster clinical effectiveness and advance a culture of excellence.

But the organization was also redesigning its care delivery model, evolving into a full-scale clinically integrated network. It needed a physician executive who could integrate and align care across the system--to help fulfill the varied mandates required of accountable care organizations today and wield influence throughout service lines and system-sponsored physician practices.

This executive had to be an M.D. (or D.O.) who was willing to serve as the primary physician voice for clinical strategy and program development decisions. Responsibilities would include working with the increasingly important managed care side of the business as well as spearheading clinical initiatives aimed at maximizing the efficiency of clinical operations, improving patient service, and enhancing quality and safety outcomes.

In short, the system needed a physician executive to provide clinical, operational and strategic leadership necessary to help the CEO lead the journey to deliver high-value care. My answer to this particular system CEO was: “You’re looking for a chief clinical officer.”

For some people this might be a matter of semantics--from one organization to the next, the roles of CMO and CCO often overlap and the titles are somewhat interchangeable. My point to this particular CEO was that it needed a physician executive who saw the organization not as a top-down traditional clinical entity, but who could also look sideways across the network and see opportunities for clinical performance improvement, integration and coordination of care across the continuum. Thus, the CCO title seemed more appropriate in this case.

New skills

For years, a hospital or health system’s chief medical officer was prized for his or her medical background and ability to relate to fellow physicians. Those qualities are still essential, yet the role of the CMO or other chief physician executives has been turned upside down, or at least sideways. In many cases, the CMO title has evolved to a chief clinical officer to reflect changing expectations of leadership.

Some of the key competencies we are seeing in CCOs include:

  • The ability to lead multidisciplinary teams across multiple service areas and facilities
  • Insurance and managed care expertise (and even direct experience)
  • Strategic business development
  • A systems approach to problem solving, consensus building and process improvement
  • Exceptional soft skills such as relationship-building, communications, listening, negotiation and diplomacy

It is not easy to find individuals with these skills and tools, especially since, as HFMA notes, demand outpaces supply for physician leaders today. In terms of soft skills, the research that my firm has conducted suggests that top physician executives naturally tend to exhibit resilience, an even temper, and are willing to share success.

Some of the hard skills and tools can be gained in MBA programs, and many of today’s leading CMO and CCO candidates have a business degree to complement their leadership skills and years of experience in the care arena.

The managed care aspect is also something characteristic of today’s CCO. Even a decade ago, it would have been unusual for a system’s leading physician to weigh in on payer issues and support strategies related to risk-based contracting.

That said, the CMO/CCO discussion can come down to a matter of semantics, depending on the organization. Other titles that we are seeing for this critical physician executive role include chief integration officer, physician-in-chief, chief transformation officer, and so forth.

The title is important, but what is more important is that there is a need for physician executives to take on many more, and new, responsibilities than in the past, especially across ever-expanding networks. This executive is looking sideways as well as down.