The Exec: What It Takes to Be an Effective Physician Leader

HL: What are your primary clinical challenges now that the crisis phase of the coronavirus pandemic has passed?

Ciaramita: The big one is providing the breadth and the quality of clinical care with the highest level of patient satisfaction in the setting of a massive workforce challenge. Finding enough staffing and retaining enough staffing throughout our clinical areas is a challenge.

HL: What kind of workforce shortages are you experiencing at Mercy?

Ciaramita: Our workforce shortages are similar to the trends nationally. Within Mercy, our biggest challenges are in the areas of support services and clinical services. We have shortages in nurses, medical assistants, medical receptionists, imaging technicians, operating room technicians, and other positions.

Most of the shortages are not simply because of wages. Most of the shortages are the result of a workforce that demands flexibility … such as changes to their work schedule.

From our perspective, our number one strategy for workforce shortages is focused on retention. We have many great employees, which are the singular reason for why we are a high-quality ministry, and we have achieved some of the best patient satisfaction in the country. We know that comes from the employees who are with us today.

HL: What are you doing in terms of recruitment and retention?

Ciaramita: We have refined our recruitment process. We have identified areas to improve the onboarding of every employee who works within our ministry. We have shortened the timeline when someone applies for a job. We have made a lot of our recruitment electronic and user-friendly.

We have offered several different types of bonuses such as sign-on bonuses and bonuses for referral of new employees. We are keeping up with the market, and we are making sure that we are valuing employees financially with compensation that is commensurate with our desire to bring in the best of the best. We are also partnering with educational institutions to help build a pipeline of future employees.

We are continuing to refine our work toward automation. This is not automation to eliminate positions. It is automation to augment positions—knowing that as healthcare demands grow as our communities age and the demand for complex care grows, we will likely never have enough human beings to deliver care. We will continue to work on automating tasks, while we are partnering with institutions to build a pipeline of nurses, advanced practice practitioners, medical assistants, operating room technicians, and other healthcare workers.

I cannot stress enough the financial, cultural, quality, and distinct workforce benefits by focusing on retention. We hold town halls—we are assessing how we can meet the needs of our staff.

We have created a gig workforce program. Our gig program is similar to agency or contracted labor. We created our own internal program that provides flexible hours and ease of scheduling. So, for our own nurses, for example, some of whom may work 40 hours a week or some of whom may work 30 hours a week, they can go into our gig program and pick up an additional two hours, or four hours, or 16 hours if they want. They can work in different areas, but they are still Mercy employees. They can work when they want, how they want, and in the setting that they want.

HL: What are the primary elements of patient safety at Mercy?

Ciaramita: We have instilled in our co-workers—our clinicians and every single person who has the honor to touch a patient that we serve—a culture of first and foremost do no harm. If you look at Mercy’s commitment to quality, we have made a commitment in every community that we serve to be the number one high-quality healthcare provider by nationally reported metrics.

We have created a culture of reporting that not only covers lapses in care and errors but also promotes reporting of near misses. In near misses, there was not a safety event but there could have been a safety event. Our co-workers are focused on learning from errors and near misses rather than having a punitive approach. How can we find out what happened? How can we document an incident? How can we bring in a team to do an analysis to make sure that we can broaden our educational opportunities about what happened in every community we serve? This work is reflected in our high quality scores.

We utilize our electronic health record to create alerts to avoid medication errors and vaccine administration errors. We have very robust systems in our EHR to avoid those errors.

I would put our patient safety under the auspices of our dedication to an overall high-quality system. That high-quality system within our ministry all falls under a newly created department called the Office of Clinical Excellence. This department is using evidence-based medicine, technology augmentation, and a humanistic approach to education, culture, and learning to drive patient safety.