Dr. McNamara peers think he’s effective in both of his roles. “As CEO, Tom may touch a dozen topics in a given day,” Arner says. “The boiler breaks, he does a community lecture, talks to unhappy cafeteria workers. It’s so many different things.” Because Dr. McNamara is a working physician, his words greatly affect the groups he lectures. “The fact that he is still treating patients builds confidence, especially in a small community, that the hospital is a high-quality institution,” Dr. Arner adds.
Even the nursing department is in Dr. McNamara’s corner. Shelia Hatmaker, Stonewall Jackson’s director of nursing for more than two years, appreciates the fact Dr. McNamara respects the role of nurses and understands how to address nurse-specific issues. “Tom values the partnership with nurses who are with the patients all day,” Hatmaker says. “He is my boss, but he respects and seeks out opinions from a nursing point of view.”
As CEO, “Tom can create an environment where the staff feels safe to practice and speak up when something is wrong,” she says. “They have to feel comfortable saying they almost made a mistake, because it’s often the system that needs changing.”
Agent of Change
Those system changes are now Dr. McNamara’s problem, but he’s well prepared, having earned a master’s degree in medical management from Carnegie Mellon University in 2006, 19 years after finishing his residency in family practice at McKeesport Hospital in Pennsylvania, and receiving certifications from the American College of Physician Executives.
Nevertheless, Dr. McNamara had serious reservations about leaving clinical medicine. “Clinical medicine is why I became a doctor in the first place,” he says.
Working as a hospitalist and serving as the hospital’s chief executive allows Dr. McNamara to provide patient care and lead at the same time, setting an example for admission-time standards, physician-to-physician communication, and relationships with specialists, nurses, and ancillary staff, says Dennis Means, MD, also a member of the Carilion management team. From a practical point of view, it also gives the regularly rotating doctors a break. Dr. McNamara works weekend shifts every few weeks.
Still, the new CEO has more than patient care to consider. “I’ve really been struck by how high costs are and how much reimbursements are being cut back,” he says. “I was always aware of cost issues, but now I have to figure out the best way to use our scarce resources. It doesn’t change what I do for patients, but I’m even more aware that money is very tight and I have to recognize that we can’t meet every need.”
It helps to be part of the larger Carilion system, as Stonewall Jackson is in the process of integrating with the other Carilion facilities. “We are a very small facility providing basic services, but we can tap into the capabilities of much larger Carilion institutions and people to serve this community,” Dr. McNamara says.
Hatmaker, the nursing director, isn’t surprised to hear that’s how Dr. McNamara the new CEO feels. “That’s Tom,” she says. “He wants to take care of this community. And the patients just might have the head of the hospital as their doctor. How cool.” TH