The son of a hospital CMO, John P. Lynch, MD, is constantly pushing himself and his organization to outdo itself. Some might say it's in his bloodline. Since 2009, he has served as CMO at Barnes-Jewish Hospital in St. Louis, a 1,260-bed facility where he plays a multidimensional role. He treats patients as an internist, trains medical residents as a faculty member, and develops new strategies and goals for quality care as a physician executive. The job fits his personality perfectly, he says.
Each of Dr. Lynch's administrative decisions are grounded in years of clinical practice. He completed his residency at Barnes Hospital before it merged with The Jewish Hospital of East St. Louis in 1996. Afterwards, he completed a fellowship in pulmonary and critical care medicine at Washington University School of Medicine, where he delivered care in a team-based setting that has since come to play a major role in his leadership.
Here, Dr. Lynch discusses the transition from clinical to administrative work, how he aims to serve as a mentor to others, and how he cultivates a spirit of continuous improvement within himself, physicians and the hospital as a whole.
Q: As someone with both clinical and administrative leadership experience, what are some of the common gaps between the two?
Dr. Lynch: I think this is a particularly important question. Like most physicians with a career path that takes them into administrative roles, I started as a clinician. I took care of individual patients with their unique issues. In the role of CMO, I spend a lot more time thinking about populations of patients and the structures and systems of healthcare that support those populations.
Before, I was really focused on individual patient issues, but I also practiced in a team environment. I started my clinical practice at Barnes Jewish as a pulmonologist with a focus in advanced lung disease in lung transplantation, and there was a team-based approach to care here. In the last decade, healthcare delivery has really evolved in that direction. In many ways, that [team-based care] really set me up to think about population issues.
Thinking about systems and the way we knit our care together can be challenging at times, particularly when you're wearing both hats. Today, I'm in service with my medicine team and working one-on-one with patients in a complex teaching environment. I spend 6-8 weeks out of the year tending to our general medicine service. But I started my morning today with a strategic planning meeting for Barnes-Jewish, Children's Hospital and Washington University School of Medicine. Over the next 10 years, we're renewing our campus infrastructure with an investment of over one billion dollars while at the same time building in new models of care. So today is very much a snapshot of my range of responsibilities here.
Q: What are some of the most important quality initiatives underway at Barnes-Jewish right now?
Dr. Lynch: Over the last several years, our safety and quality initiatives have focused heavily in the area of transitions and handoffs. We have developed concise handoff tools that reside the electronic medical record and are available to any caregiver. We have redesigned our hospital discharge processes to promote safer transition to the next level of care — with a particular focus on medicine reconciliation. Successful pilot projects aimed at reducing errors associated with high risk medications and reducing patient falls will be expanded across all units.
To support these important initiatives, our quality program has evolved in an interesting way over the last 5-6 years. As an organization, we have really embraced the Lean approach, which was adapted from the Toyota production system. In addition to improvements in quality and safety, the lean approach to managing continuous improvement also has the six major goal areas of our hospital — the others being service, staff development, innovation and finance. We think about those six major areas and try to use value stream analysis and rapid improvement processes to improve outcomes in those areas. Using value stream analysis, we break down complicated processes. Then the people who actually use those processes redesign them as they'd like to see care delivered for their patients. Rapid improvement events are then used to drive our systems of care toward the future state.
I'd say we've been using the Lean model for roughly six years and during that time it has been completely integrated into the way we do our work — not just how we manage projects. BJH employees come to work every day with the spirit of continuous improvement.
Q. Can you talk about how you manage your day? As a practicing physician, faculty member and hospital administrator, how do you juggle your responsibilities?
Dr. Lynch: Juggle is probably the right word. Although my daily schedule is usually very full I do try to reserve up to two hours a day to answer emails, communicate with the medical staff and read on topics related to the issues of the day. As I interact with other CMOs I find, in general, that we all enjoy how this position can have such a broad impact on large numbers of patients — patients that we will never know personally but who will benefit from the safety and quality initiatives that we support.
We enjoy thinking about systems and populations, and yet we all come from clinical backgrounds. We all have that connection back to when we provided care to individual patients. That background helps me a lot. As I think back on some of the experiences I have as a caregiver, I now use those experiences strategically to address issues related to how we provide care as a system. Personally, I enjoy the breadth of challenges that come to this office every day.
Q. Do you have any daily routines when it comes to communication with physicians or patients? How do you stay attuned?
Dr. Lynch: I remain clinically active — I round frequently with a resident team so that I can experience, firsthand, the systems that we've developed here and try to reach an understanding of the end product. I round frequently with managers and directors from clinical areas. I also have responsibilities for ambulatory services here at Barnes-Jewish, so I round with that team and interact with patients. We also use a variety of techniques to communicate in different formats with residents and medical staff. We have more than 800 residents here every day, so we use multimedia approaches to message around important clinical issues and around our continuous improvement activities.
Q: What elements of healthcare today excite you most?
Dr. Lynch: I really think that the emphasis in population-based healthcare will improve and will be a key driver in the improvement of quality care. The more we think about the systems of care we develop, and the more we think about populations of patients and their needs, the more likely we are to design systems that provide the types of outcomes we need.
The other thing that's exciting, which is also inherent in the way we provide care, is the new requirement for team-based care. As we focus on that, we will drive better communication and a better patient experience in a safer environment. Because I practiced in the lung transplant environment, it was multi-disciplinary from the start. Patients had a pre-transplant team, pharmacist, social worker, surgeons, anesthesiologists — all of these roles were involved in the care of the patient.
In 1996, I was a junior faculty member and named the first medical director of a new ventilating unit at Barnes-Jewish. Patients with chronic respiratory failure who were in different ICUs were placed in one unit for rehab, recovery and eventual discharge. With that experience, we started to look at interventions in care and the development of protocols that could be applied to patients. That was team-based care using a systematic approach, and that's still the model I'm most used to.
Q. Have you had any memorable mentors in your career? Do you try to serve as a mentor for others?
Dr. Lynch: My father was a physician in a small town in Florida. Back then, his was more of a traditional family physician role. I saw how he balanced his work with his life and his dedication to patients. He was the only board-certified internist in our area. Through his hard work and dedication, I saw his patients getting better and the respect he garnered from other physicians. He was an excellent communicator. He eventually became the CMO at his local hospital as well.
I've had wonderful clinical mentors here at Barnes-Jewish and Washington University — almost too many to mention. Some were the real early leaders in the lung-transplant field — Drs. Alec Patterson and Bert Trulock. They really showed dedication to patient care and innovation, and were pioneers in that field. Dr. Jim Crane, who is CEO of faculty practice plan at Washington University, gave me some of my earliest administrative responsibilities.
Mentoring other physicians is very important — in this role, it's one of the things I need to think about as a leader. I need to think about developing the next generation of physician leadership and the other hospital leadership that report through this office. I'm fortunate to be able to access the highly developed talent management program at BJC Healthcare. The program gives structure and a process to allow our emerging leaders to further develop their skills and give them new opportunities. But it does take a conscious effort — you have to give opportunities to others, continuously mentor and provide opportunities for growth.
Q. How do you push yourself and your clinical team to do better?
Dr. Lynch: I think the environment in healthcare demands it now. The bars that are set for quality and safety get harder and harder to reach every year. In healthcare today, if you're not improving, you're essentially falling behind. There's an imperative for continuous improvement that most of my colleagues understand now.
One of the biggest trends in past 10 years has been transparency in outcomes. I tell physicians in training that outcomes will, forever, be transparent to patients and other physicians, so they need to continually pick up the skills and techniques that allow them improve. Hospitals and health systems face the same challenge — to remain national leaders, we have to get better every day.
Q. Finally, any tips for other CMOs or physicians who want to become CMOs or hold executive positions?
Dr. Lynch: For clinicians interested in an administrative role, I would tell them to go ahead and take a chance. Volunteer to sit on or lead a committee. Take an opportunity if you're asked. Try it on. If you enjoy that experience, then consider getting some additional training or exposure to the fundamentals of management.
In this role and in most leadership roles, you're dealing with continuous change. Understanding how to promote change in complex systems is an important asset, so I would recommend seeking out educational experience related to change management. Project management principals are also important in healthcare leadership roles. On the finance side, one of the things I didn't understand at first was how capital is allocated in healthcare. When I moved into hospital administration, I specifically spent time with our CFO and controller to improve my understanding of our financial systems and controls.
Each of Dr. Lynch's administrative decisions are grounded in years of clinical practice. He completed his residency at Barnes Hospital before it merged with The Jewish Hospital of East St. Louis in 1996. Afterwards, he completed a fellowship in pulmonary and critical care medicine at Washington University School of Medicine, where he delivered care in a team-based setting that has since come to play a major role in his leadership. Here, Dr. Lynch discusses the transition from clinical to administrative work, how he aims to serve as a mentor to others, and how he cultivates a spirit of continuous improvement within himself, physicians and the hospital as a whole.
Q: As someone with both clinical and administrative leadership experience, what are some of the common gaps between the two?
Dr. Lynch: I think this is a particularly important question. Like most physicians with a career path that takes them into administrative roles, I started as a clinician. I took care of individual patients with their unique issues. In the role of CMO, I spend a lot more time thinking about populations of patients and the structures and systems of healthcare that support those populations.
Before, I was really focused on individual patient issues, but I also practiced in a team environment. I started my clinical practice at Barnes Jewish as a pulmonologist with a focus in advanced lung disease in lung transplantation, and there was a team-based approach to care here. In the last decade, healthcare delivery has really evolved in that direction. In many ways, that [team-based care] really set me up to think about population issues.
Thinking about systems and the way we knit our care together can be challenging at times, particularly when you're wearing both hats. Today, I'm in service with my medicine team and working one-on-one with patients in a complex teaching environment. I spend 6-8 weeks out of the year tending to our general medicine service. But I started my morning today with a strategic planning meeting for Barnes-Jewish, Children's Hospital and Washington University School of Medicine. Over the next 10 years, we're renewing our campus infrastructure with an investment of over one billion dollars while at the same time building in new models of care. So today is very much a snapshot of my range of responsibilities here.
Q: What are some of the most important quality initiatives underway at Barnes-Jewish right now?
Dr. Lynch: Over the last several years, our safety and quality initiatives have focused heavily in the area of transitions and handoffs. We have developed concise handoff tools that reside the electronic medical record and are available to any caregiver. We have redesigned our hospital discharge processes to promote safer transition to the next level of care — with a particular focus on medicine reconciliation. Successful pilot projects aimed at reducing errors associated with high risk medications and reducing patient falls will be expanded across all units.
To support these important initiatives, our quality program has evolved in an interesting way over the last 5-6 years. As an organization, we have really embraced the Lean approach, which was adapted from the Toyota production system. In addition to improvements in quality and safety, the lean approach to managing continuous improvement also has the six major goal areas of our hospital — the others being service, staff development, innovation and finance. We think about those six major areas and try to use value stream analysis and rapid improvement processes to improve outcomes in those areas. Using value stream analysis, we break down complicated processes. Then the people who actually use those processes redesign them as they'd like to see care delivered for their patients. Rapid improvement events are then used to drive our systems of care toward the future state.
I'd say we've been using the Lean model for roughly six years and during that time it has been completely integrated into the way we do our work — not just how we manage projects. BJH employees come to work every day with the spirit of continuous improvement.
Q. Can you talk about how you manage your day? As a practicing physician, faculty member and hospital administrator, how do you juggle your responsibilities?
Dr. Lynch: Juggle is probably the right word. Although my daily schedule is usually very full I do try to reserve up to two hours a day to answer emails, communicate with the medical staff and read on topics related to the issues of the day. As I interact with other CMOs I find, in general, that we all enjoy how this position can have such a broad impact on large numbers of patients — patients that we will never know personally but who will benefit from the safety and quality initiatives that we support.
We enjoy thinking about systems and populations, and yet we all come from clinical backgrounds. We all have that connection back to when we provided care to individual patients. That background helps me a lot. As I think back on some of the experiences I have as a caregiver, I now use those experiences strategically to address issues related to how we provide care as a system. Personally, I enjoy the breadth of challenges that come to this office every day.
Q. Do you have any daily routines when it comes to communication with physicians or patients? How do you stay attuned?
Dr. Lynch: I remain clinically active — I round frequently with a resident team so that I can experience, firsthand, the systems that we've developed here and try to reach an understanding of the end product. I round frequently with managers and directors from clinical areas. I also have responsibilities for ambulatory services here at Barnes-Jewish, so I round with that team and interact with patients. We also use a variety of techniques to communicate in different formats with residents and medical staff. We have more than 800 residents here every day, so we use multimedia approaches to message around important clinical issues and around our continuous improvement activities.
Q: What elements of healthcare today excite you most?
Dr. Lynch: I really think that the emphasis in population-based healthcare will improve and will be a key driver in the improvement of quality care. The more we think about the systems of care we develop, and the more we think about populations of patients and their needs, the more likely we are to design systems that provide the types of outcomes we need.
The other thing that's exciting, which is also inherent in the way we provide care, is the new requirement for team-based care. As we focus on that, we will drive better communication and a better patient experience in a safer environment. Because I practiced in the lung transplant environment, it was multi-disciplinary from the start. Patients had a pre-transplant team, pharmacist, social worker, surgeons, anesthesiologists — all of these roles were involved in the care of the patient.
In 1996, I was a junior faculty member and named the first medical director of a new ventilating unit at Barnes-Jewish. Patients with chronic respiratory failure who were in different ICUs were placed in one unit for rehab, recovery and eventual discharge. With that experience, we started to look at interventions in care and the development of protocols that could be applied to patients. That was team-based care using a systematic approach, and that's still the model I'm most used to.
Q. Have you had any memorable mentors in your career? Do you try to serve as a mentor for others?
Dr. Lynch: My father was a physician in a small town in Florida. Back then, his was more of a traditional family physician role. I saw how he balanced his work with his life and his dedication to patients. He was the only board-certified internist in our area. Through his hard work and dedication, I saw his patients getting better and the respect he garnered from other physicians. He was an excellent communicator. He eventually became the CMO at his local hospital as well.
I've had wonderful clinical mentors here at Barnes-Jewish and Washington University — almost too many to mention. Some were the real early leaders in the lung-transplant field — Drs. Alec Patterson and Bert Trulock. They really showed dedication to patient care and innovation, and were pioneers in that field. Dr. Jim Crane, who is CEO of faculty practice plan at Washington University, gave me some of my earliest administrative responsibilities.
Mentoring other physicians is very important — in this role, it's one of the things I need to think about as a leader. I need to think about developing the next generation of physician leadership and the other hospital leadership that report through this office. I'm fortunate to be able to access the highly developed talent management program at BJC Healthcare. The program gives structure and a process to allow our emerging leaders to further develop their skills and give them new opportunities. But it does take a conscious effort — you have to give opportunities to others, continuously mentor and provide opportunities for growth.
Q. How do you push yourself and your clinical team to do better?
Dr. Lynch: I think the environment in healthcare demands it now. The bars that are set for quality and safety get harder and harder to reach every year. In healthcare today, if you're not improving, you're essentially falling behind. There's an imperative for continuous improvement that most of my colleagues understand now.
One of the biggest trends in past 10 years has been transparency in outcomes. I tell physicians in training that outcomes will, forever, be transparent to patients and other physicians, so they need to continually pick up the skills and techniques that allow them improve. Hospitals and health systems face the same challenge — to remain national leaders, we have to get better every day.
Q. Finally, any tips for other CMOs or physicians who want to become CMOs or hold executive positions?
Dr. Lynch: For clinicians interested in an administrative role, I would tell them to go ahead and take a chance. Volunteer to sit on or lead a committee. Take an opportunity if you're asked. Try it on. If you enjoy that experience, then consider getting some additional training or exposure to the fundamentals of management.
In this role and in most leadership roles, you're dealing with continuous change. Understanding how to promote change in complex systems is an important asset, so I would recommend seeking out educational experience related to change management. Project management principals are also important in healthcare leadership roles. On the finance side, one of the things I didn't understand at first was how capital is allocated in healthcare. When I moved into hospital administration, I specifically spent time with our CFO and controller to improve my understanding of our financial systems and controls.
Related Articles on Hospital CMOs:
Leveraging Multidisciplinary Teams to Improve Quality: Q&A With Christiana Care CMO Dr. Janice Nevin
Hospital and Health System CMOs on the Move (January 2012)
Leading Through Unprecedented Change: 6 Behaviors CMOs Must Master