When David Levine, MD, took over full time in January as chief medical officer of Fisher-Titus Health in Norwalk, Ohio, he decided it was time to "stop doing things the way they've always been done."
That was not a small feat, he told Becker's. In his previous position as regional director of a healthcare system with 16 hospitals, he saw the writing on the wall almost from day one, when he was taken aside by a senior leader after a meeting.
"I was so frustrated. I offered some suggestions about ways to make some improvements, just thinking I would share successful initiatives I'd seen at other hospitals," Dr. Levine said. "After the meeting, a colleague pulled me aside and said, 'Hey, you know what … first, welcome, we are glad to have you here. But also, by the way, we are not looking for your input in what you think we should do. These are leadership decisions to make. We manage it the way we want. You're here as a guest in our house."
Time went on and he paid attention to how employing a "that's the way we've always done it" philosophy was affecting clinicians. He had the opportunity to see the inner workings of many facilities as a regional director and discovered two things.
First, hospital challenges were virtually the same wherever he went. "Different dynamics, different people — some hospitals were dealing with much larger volumes of patients," Dr. Levine said. "But the core roots of the problems, the real pain points, were the same."
The second problem, which he believes is the core of clinician burnout in today's hospital environments, is what he calls "recycled" physicians and administrators.
"I kept seeing this. We identified a provider that wasn't good. They didn't do their charting. They had poor patient experience scores. They fought with the nurses. And then we would move them to another facility. Or they would just move from one hospital to another outside the system. And then they would create the same problems there."
He saw the same pattern with administrators. "You have hospital administrators that are doing a poor job at one hospital and they leave that facility, go to another facility and create the same kind of chaos that they created at the first one. I've watched them migrate down the interstate, going from one hospital to the next and always doing that same thing."
When he left regional administration behind for his new position as chief medical officer of a rural Ohio hospital, he made it a point to give clinicians a voice. And although he acknowledges it is difficult to make major changes in a hospital overnight, small changes add up.
Physicians have some great ideas and they also have a lot of ability to help influence the dynamics of an organization, he said, but "they've gotten frustrated over years and years of feeling like their voices are not being heard."
With an eye on maximizing efficiency, he looked to his staff. They told him there were many things that could be done more simply, but, again, they were doing it "the way it had always been done."
When he asked and actively listened, Dr. Levine said he was able to make some changes right away at Fisher-Titus.
For example, surgeons requested changes to the preoperative policies put in place because of COVID-19. "I looked at the policy and realized we could change it. It didn't require committee meeting after committee meeting. I changed it to be more in line with what the surgeons believed is necessary now."
A bigger project Dr. Levine is tackling involves the new EMR the health systemFisher-Titus put in place. It was designed based on prior hospital functions, and the physicians told him the new system does no't communicate the way they need it to.
"I realized this system should meet our physicians' needs. It has to be designed based on current workflow," he said.
He asked physicians about the challenges and learned what they needed. Then Dr. Levine he found out the new system can be purchased in modules and adapted various functionalities to meet a hospital's individual needs. "Our big project this year is going back and identifying which pieces of the puzzle don't work and making changes based on what the physicians told me would work best for them,.." he said.
Dr. Levine said he believes providers are starting to see that his open mind and willingness to find ways to put their ideas into action will create an environment where "physicians get reengaged because they know their opinions matter."