Spearhead QI
For Dr. Sperring, advancement to the C-suite was a journey that began nine years ago, following four years in community-based practice. “I absolutely loved the relationships with my kids and families, but I missed the acute-care role,” he says.
In 2002, Riley Hospital recruited him to help start its pediatric hospitalist program. As the program grew to include 22 hospitalists at four affiliated hospitals, his responsibilities also grew to associate chief medical officer in 2007 and chief medical officer in 2009. Along the way, he worked on partnering with pediatricians in the community, spearheaded a quality program that successfully reduced length of stay in the hospital, and developed an integrated call center for hospital admissions across the health system.
By contrast, Steve Narang, MD, CMO of Banner Health System’s pediatric services and its new Cardon Children’s Medical Center in Mesa, Ariz., says he always had one eye on healthcare system and policy issues, even during residency.
“What clearly became the center of my work is the value equation,” he says. “I wanted to be in a career where I could impact on delivering and disseminating best practices in medical care. I wanted to find out what are the best approaches for taking care of patients.”
After residency, Dr. Narang moved to New Orleans in 2000, where he started an academic pediatric hospitalist program at Louisiana State University Medical Center. He later helped launch a firm called Pediatric Hospitalists Louisiana, which collaborated with hospitals across the state to improve pediatric care delivery. “That got me thinking about things more from the management perspective, how to fix gaps in the system and advance our ability to measure quality in pediatric hospital medicine,” he says.
“When you take your first job in the hospital and you start trying to define and design best practices, people look at you differently—not as a young, emerging physician but more as a physician leader. They come to you and say: ‘Will you chair this committee, or lead that effort?’” he says. “And then, suddenly, you run out of tools in your toolbox. That’s what happened to me.”
He enrolled at Harvard University in pursuit of a business degree, along the way learning new ways of looking at systems change and basic principles of financing.
Retain a Clinical Presence
“The great thing about being a hospitalist is that you’re at the intersection of everything that happens in the hospital,” Dr. Narang says. As the pediatric chief medical officer for Banner Health, he is responsible for strategic planning, quality improvement (QI), and patient safety for a 210-bed hospital. He also co-chairs the Clinical Consensus Group, which represents all of Banner’s 23 hospitals, where he is able to influence care processes at the other hospitals as well.
Many hospitalist leaders eventually confront the dilemma of whether growing administrative responsibilities stand in the way of a continuing clinical practice. Dr. Narang moonlights some evenings and weekends on hospitalist and emergency medicine shifts. However, despite still wanting to see patients, he wonders if he has reached the point where growing administrative responsibilities will make that impossible.
“It was a challenge when I became CMO to squeeze in clinical responsibilities,” Dr. Narang says. “But I believed that in order to be the right kind of CMO, I still needed to practice medicine … to know what’s happening on the floor and what still needs to be fixed. You also want your colleagues to see you as a credible physician.”