Keith Churchwell, MD, was named executive director and CMO of Vanderbilt Heart and Vascular Institute in July of 2009.
Vanderbilt Unive
rsity Medical Center, which includes the Vanderbilt Heart and Vascular Institute, was one of the top-grossing hospitals in 2011 with $4.52 billion in total patient revenue, according to CMS cost report data analyzed by the American Hospital Directory. Additionally, U.S. News & World Report ranked Vanderbilt University Medical Center amongst the top 40 on its Best Hospitals for 2011-2012 List.
Dr. Churchwell's background as a clinician and cardiologist guides his open door and humor-filled management style. Here he discusses his goals in the face of healthcare reform and innovation, his desire to surround himself with hard-working, collaborative individuals and his grassroots approach to executive leadership.
Q: What goals do you have for the Vanderbilt Heart for 2012?
Dr. Churchwell: One of the major goals for this year and for the whole medical center centers on financial issues. We are working to maximize our financial margin so we can fund innovative projects and prepare for what is down the road. Within the Vanderbilt Heart and Vascular Institute, we are looking closely at key projects surrounding acute episodic care for cardiovascular disease that improves and enhances our care model. The goal is to maximize our opportunity to use novel approaches to patient cardiovascular care that achieve the goal of better outcomes and greater efficiency. We want the care to be a win for VHVI and for the patient. We would like to enhance the whole package, which includes minimizing costs and maximizing outcomes.
Another major goal is to truly “bundle” the patient’s cardiac care under one care plan. We have spent the last 10 months working on this key project at VHVI. At Vanderbilt, we take care of very ill patients providing surgical procedures that are remarkable in righting the wrongs of the patient's cardiovascular problem. However, that is only part of what we do. Our goal is to look at the totality of patient care. It is essential that the patients understand their disease process. We need to ensure that patients are taking their medicine and that we are taking steps to help put the patient back on the right track from both a physical and mental standpoint. We want to communicate with the patient's local physicians and care providers so they are also a part of this plan and give the patient the best chance for a full recovery.
Q: How are you working toward achieving those goals?
KC: The first level of achieving any goal is making sure we have the right staff to get that done. Do we have the appropriate people to maximize care within the hospital environment? We really need to understand the day-to-day work of the hospital; what are the appropriate interlocking parts from a personal and technological standpoint? Once we have those key parts identified, the next question is how do we use them to the best of our ability?
We also need to determine if there is excess in the system. If so, where is it? Is there a better way to use our people, and if there is waste, how can we get rid of it? Where are we not placing enough resources, and how are those deficits leading to problems in care? How can we prevent those rollbacks from occurring, and how are we encouraging and receiving the best work out of our staff?
Q: What are your biggest challenges as executive director and CMO?
KC: The first challenge is that Vanderbilt is such a large, extensive system. To overcome this, I like to encourage the idea of teamwork. All the staff — support staff, cardiologists, nursing and tech support staff — are a part of what makes Vanderbilt a great medical center and medical school. I want to encourage the staff to act and work in a way that represents Vanderbilt in the best light — a "they are we, we are they" mentality. Thinking in that mindset is extremely important because if not, we are disparate in our approach to problems, and we will not be as effective.
Additionally, it is important to ask for innovation in our thinking about issues that arise so problem solving becomes an opportunity to improve. I want the atmosphere to be "everyone rowing together, in the boat, in the same direction."
Q: How do you try to encourage that mentality and environment of "everyone rowing together"?
KC: We set meetings with all the parts of the staff at VHVI on a regular basis. Sometimes that is not as successful, but I still try. Face time is extremely important. I want to be transparent with questions, concerns and new initiatives. It is essential to get input from all the people who have ideas to share. When I understand their issues, I can handle the big questions, keeping their perspective in mind.
Q: It sounds like you utilize a grassroots strategy. What helps you accomplish that?
KC: Having an excellent administrative staff is essential. Then, realizing that part of my job is being a cheerleader and supporting my staff. It is important that I am able to look at the larger picture, the whole picture, as well as work with the staff and gather their ideas. I have a unique position because I am a clinical cardiologist as well as have responsibilities with senior management. I can see from the ground level what has been and is effective, and then I can talk with executives and partners and see their perspective. The view from both levels is very helpful.
Q: We were discussing challenges for this year, I would imagine that other challenges might revolve around healthcare innovation through technology. What is your strategy for incorporating new healthcare technologies?
KC: Well, you are right in that healthcare technology can be a challenge to integrate. Currently we are in another renaissance with cardiovascular technology and the ability to care for patients. In the late 1970s, there was a new age of revascularization with angioplasty. We are now looking at the age where diagnostic and therapeutic techniques are taking another significant leap forward. As an example, cardiologists and cardiac surgeons can now replace an aortic valve without opening the sternum — a tremendous advance — which will usher in other technological advances and also new care models that should be more efficient, less costly and better for our patients.
With my staff, we are closely evaluating how to continue to integrate the findings of new cardiovascular research and translate those advances into our daily work. What are the results in terms of outcomes from a therapeutic standpoint? We also evaluate the technologies from a financial standpoint — what is the cost to Vanderbilt? What is the cost to the patient? How is it being paid for? How can we be sure that reimbursement is in line with the cost of the procedure and the results? Right now, these questions are key points in conversations at Vanderbilt and on a national level.
Q: You are rounding out your third year as executive director and CMO, what is your proudest accomplishment?
KC: I can’t think of one single accomplishment, but I am proud of helping to keep the idea of an interlocking, interdisciplinary institute all together and that everything is still moving forward.
Vanderbilt Heart has been able to integrate mature, successful cardiologists who have been in practice for a significant period into an aggressive academic and clinical model of care. The newer cardiologists have thrived and joined successfully with cardiologists who have grown up on this campus. I am proud of that — of our ability to retain physicians and grow careers.
Q: Hospital-physician relationships are very important to healthcare. Why do you think Vanderbilt has such great relationships with its physicians?
KC: Again, we have great administration, from the chairman of cardiac surgery, John Byrne; the chief of cardiovascular medicine, Douglas Sawyer; Robin Steaban, our CNO for Vanderbilt Heart and many others — are all examples of hardworking, dedicated people to this work. They have created a productive, collaborative environment. The physicians and cardiologists respond well to that, and thus far, there has been no burning of torches at the barricades.
Q: How would you describe your management style?
KC: I hope that my style has a bit of humor. I try to be open, firm and more than willing to hear and incorporate other viewpoints. I try to give those who have expertise and who want to grow the opportunity to do so.
The meetings I run are never terribly serious. It is OK for me to be the butt of the jokes if that puts people at ease as they go forward.
I try to make it my role to ensure that I hear everybody's viewpoints, from around the room, during a meeting. When I find I am the only one speaking for an extended period, I try to take a step back. I find the most benefit derives from meetings when thoughts and ideas percolate.
Q: What is the best piece of advice you have been given?
KC: My father, who passed away three years ago, gave me some advice when I was offered the position: "You need to [take the position] while you are young and use that youth to your advantage! Work hard as executive director and CMO; use your energy to do the best job possible and to see what you can make of the position."
I think that is great advice because sometimes one may hesitate when they take on a significant responsibility. The best way to grow as an individual intellectually and emotionally is take on responsibilities like [being executive director and CMO]. It is important to remember that others saw qualities within you that may be extremely helpful for moving a bigger agenda forward — it is important to take advantage of that. Be self-reflective throughout the whole process. Ask yourself if you are doing the right thing — have I made the right decision? What would I do differently next time? Be open to critical thinking. Ask those you trust what they think of your decisions. Ask people who can be honest. Surround yourself with people who will challenge you and tell you the truth.
Vanderbilt Unive
rsity Medical Center, which includes the Vanderbilt Heart and Vascular Institute, was one of the top-grossing hospitals in 2011 with $4.52 billion in total patient revenue, according to CMS cost report data analyzed by the American Hospital Directory. Additionally, U.S. News & World Report ranked Vanderbilt University Medical Center amongst the top 40 on its Best Hospitals for 2011-2012 List. Dr. Churchwell's background as a clinician and cardiologist guides his open door and humor-filled management style. Here he discusses his goals in the face of healthcare reform and innovation, his desire to surround himself with hard-working, collaborative individuals and his grassroots approach to executive leadership.
Q: What goals do you have for the Vanderbilt Heart for 2012?
Dr. Churchwell: One of the major goals for this year and for the whole medical center centers on financial issues. We are working to maximize our financial margin so we can fund innovative projects and prepare for what is down the road. Within the Vanderbilt Heart and Vascular Institute, we are looking closely at key projects surrounding acute episodic care for cardiovascular disease that improves and enhances our care model. The goal is to maximize our opportunity to use novel approaches to patient cardiovascular care that achieve the goal of better outcomes and greater efficiency. We want the care to be a win for VHVI and for the patient. We would like to enhance the whole package, which includes minimizing costs and maximizing outcomes.
Another major goal is to truly “bundle” the patient’s cardiac care under one care plan. We have spent the last 10 months working on this key project at VHVI. At Vanderbilt, we take care of very ill patients providing surgical procedures that are remarkable in righting the wrongs of the patient's cardiovascular problem. However, that is only part of what we do. Our goal is to look at the totality of patient care. It is essential that the patients understand their disease process. We need to ensure that patients are taking their medicine and that we are taking steps to help put the patient back on the right track from both a physical and mental standpoint. We want to communicate with the patient's local physicians and care providers so they are also a part of this plan and give the patient the best chance for a full recovery.
Q: How are you working toward achieving those goals?
KC: The first level of achieving any goal is making sure we have the right staff to get that done. Do we have the appropriate people to maximize care within the hospital environment? We really need to understand the day-to-day work of the hospital; what are the appropriate interlocking parts from a personal and technological standpoint? Once we have those key parts identified, the next question is how do we use them to the best of our ability?
We also need to determine if there is excess in the system. If so, where is it? Is there a better way to use our people, and if there is waste, how can we get rid of it? Where are we not placing enough resources, and how are those deficits leading to problems in care? How can we prevent those rollbacks from occurring, and how are we encouraging and receiving the best work out of our staff?
Q: What are your biggest challenges as executive director and CMO?
KC: The first challenge is that Vanderbilt is such a large, extensive system. To overcome this, I like to encourage the idea of teamwork. All the staff — support staff, cardiologists, nursing and tech support staff — are a part of what makes Vanderbilt a great medical center and medical school. I want to encourage the staff to act and work in a way that represents Vanderbilt in the best light — a "they are we, we are they" mentality. Thinking in that mindset is extremely important because if not, we are disparate in our approach to problems, and we will not be as effective.
Additionally, it is important to ask for innovation in our thinking about issues that arise so problem solving becomes an opportunity to improve. I want the atmosphere to be "everyone rowing together, in the boat, in the same direction."
Q: How do you try to encourage that mentality and environment of "everyone rowing together"?
KC: We set meetings with all the parts of the staff at VHVI on a regular basis. Sometimes that is not as successful, but I still try. Face time is extremely important. I want to be transparent with questions, concerns and new initiatives. It is essential to get input from all the people who have ideas to share. When I understand their issues, I can handle the big questions, keeping their perspective in mind.
Q: It sounds like you utilize a grassroots strategy. What helps you accomplish that?
KC: Having an excellent administrative staff is essential. Then, realizing that part of my job is being a cheerleader and supporting my staff. It is important that I am able to look at the larger picture, the whole picture, as well as work with the staff and gather their ideas. I have a unique position because I am a clinical cardiologist as well as have responsibilities with senior management. I can see from the ground level what has been and is effective, and then I can talk with executives and partners and see their perspective. The view from both levels is very helpful.
Q: We were discussing challenges for this year, I would imagine that other challenges might revolve around healthcare innovation through technology. What is your strategy for incorporating new healthcare technologies?
KC: Well, you are right in that healthcare technology can be a challenge to integrate. Currently we are in another renaissance with cardiovascular technology and the ability to care for patients. In the late 1970s, there was a new age of revascularization with angioplasty. We are now looking at the age where diagnostic and therapeutic techniques are taking another significant leap forward. As an example, cardiologists and cardiac surgeons can now replace an aortic valve without opening the sternum — a tremendous advance — which will usher in other technological advances and also new care models that should be more efficient, less costly and better for our patients.
With my staff, we are closely evaluating how to continue to integrate the findings of new cardiovascular research and translate those advances into our daily work. What are the results in terms of outcomes from a therapeutic standpoint? We also evaluate the technologies from a financial standpoint — what is the cost to Vanderbilt? What is the cost to the patient? How is it being paid for? How can we be sure that reimbursement is in line with the cost of the procedure and the results? Right now, these questions are key points in conversations at Vanderbilt and on a national level.
Q: You are rounding out your third year as executive director and CMO, what is your proudest accomplishment?
KC: I can’t think of one single accomplishment, but I am proud of helping to keep the idea of an interlocking, interdisciplinary institute all together and that everything is still moving forward.
Vanderbilt Heart has been able to integrate mature, successful cardiologists who have been in practice for a significant period into an aggressive academic and clinical model of care. The newer cardiologists have thrived and joined successfully with cardiologists who have grown up on this campus. I am proud of that — of our ability to retain physicians and grow careers.
Q: Hospital-physician relationships are very important to healthcare. Why do you think Vanderbilt has such great relationships with its physicians?
KC: Again, we have great administration, from the chairman of cardiac surgery, John Byrne; the chief of cardiovascular medicine, Douglas Sawyer; Robin Steaban, our CNO for Vanderbilt Heart and many others — are all examples of hardworking, dedicated people to this work. They have created a productive, collaborative environment. The physicians and cardiologists respond well to that, and thus far, there has been no burning of torches at the barricades.
Q: How would you describe your management style?
KC: I hope that my style has a bit of humor. I try to be open, firm and more than willing to hear and incorporate other viewpoints. I try to give those who have expertise and who want to grow the opportunity to do so.
The meetings I run are never terribly serious. It is OK for me to be the butt of the jokes if that puts people at ease as they go forward.
I try to make it my role to ensure that I hear everybody's viewpoints, from around the room, during a meeting. When I find I am the only one speaking for an extended period, I try to take a step back. I find the most benefit derives from meetings when thoughts and ideas percolate.
Q: What is the best piece of advice you have been given?
KC: My father, who passed away three years ago, gave me some advice when I was offered the position: "You need to [take the position] while you are young and use that youth to your advantage! Work hard as executive director and CMO; use your energy to do the best job possible and to see what you can make of the position."
I think that is great advice because sometimes one may hesitate when they take on a significant responsibility. The best way to grow as an individual intellectually and emotionally is take on responsibilities like [being executive director and CMO]. It is important to remember that others saw qualities within you that may be extremely helpful for moving a bigger agenda forward — it is important to take advantage of that. Be self-reflective throughout the whole process. Ask yourself if you are doing the right thing — have I made the right decision? What would I do differently next time? Be open to critical thinking. Ask those you trust what they think of your decisions. Ask people who can be honest. Surround yourself with people who will challenge you and tell you the truth.