When Reading Hospital Chief Executive Officer Scott Wolfe resigned May 7, 2010, a wave of change began.
The hospital has an almost entirely new administrative team, and doctors will have a role in all major decisions.
"This will influence the care of individual patients and influence the process of care for all patients," said Dr. Joseph Grennan, an anesthesiologist who was appointed chief medical officer in December 2010.
Since Wolfe left, the hospital has hired at least 18 directors and other executives, including a new chief executive officer, Clint Matthews, who has a nursing degree.
Therese Sucher, the new chief operating officer also has a nursing background.
At least three are physicians:
- Dr. Jorge J. Scheirer is vice president and chief medical information officer.
- Grennan is senior vice president and chief medical officer.
- Dr. David L. George is vice president of academic affairs and chief academic officer.
The hospital is transitioning to a hybrid management that includes both hospital executives and physicians making major decisions, said C. Thomas Work, chairman of the hospital's board of directors.
"No essential, fundamental decision is made without doctor consideration," Work said.
How the hospital includes doctors in decision-making is constantly evolving and won't have any end, Grennan said.
"We are striving for perfection," Grennan said. "If you want to know how to fix something, ask the frontline."
The change in management was necessary because the hospital had not been focused on developing medical leadership for a long time, Work said.
That's because the hospital was undergoing a massive transformation under former hospital CEO Charles Sullivan, who served from 1986 to 2007, he said.
During Sullivan's tenure, the hospital became a community economic engine and expanded physically, Work said.
During that growth explosion, hospital management practices fell by the wayside, he said.
"It was a casual affair," Work said. "It was time to reinvest a great deal with people."
Now physicians are beginning to be part of decisions that have huge financial implications and that guide the future of the hospital.
For example, Work said, clinicians helped choose Epic, a $180 million electronic medical records system.
To lead that effort, Dr. Scheirer was named vice president and chief information officer, a new position.
Once Epic is fully functioning in the next year or so, it will have a huge impact on patient services because doctors will be able to access medical records immediately, Work said.
"It will explode the quality of care and increase patient satisfaction," Work said.
Doctors are also playing an integral role in the design of 24 surgical suites in a $189 million surgical center on the hospital campus, scheduled to begin next year, he said.
Last spring, the board hired FTI Consulting, of Brentwood, Tenn., to review best practices among 2,500 hospitals across the country.
CEO Matthews, COO Sucher, and CFO Jones worked at FTI before joining Reading Hospital.
That study revealed that the best hospital models included physicians who made administrative decisions along with hospital executives.
Academics have debated whether hospitals that are physician-led are better than those that are not.
Hospitals ranked in the top 100 for cancer, digestive and cardiovascular care by U.S. News and World Report in 2009 were more likely to be led by physicians than by business or other health care professionals, according to a report in July.
Other researchers say medical schools must train students to be hospital leaders as well as doctors.
Stephen Gambescia, associate professor of health services administration at Drexel University, said the best model is a mix of administrators.
Hospitals that are completely physician-led typically don't survive, for reasons that have to do with mindset and skill, he said.
Gambescia said the most successful hospitals are where executives with a business background and physicians make decisions jointly.
"You want a variety of disciplines," Gambescia said. "Just having one is not a good set-up for a team."
Hospital administrators and physicians have different ways of thinking and solving problems, and most physicians don't fully understand how the hospital system works, he said.
"It comes back to the culture of the hospital," Gambescia said. "They [doctors] want to be with patients."
Those differences can be a source of conflict and cloud communication.
That's why the position of chief medical information officer was given to Scheirer, a physician, Work said.
"There's a credibility leap when administrators tell doctors how to do their craft," Work said. "Doctors talk better to other doctors."
Gambescia said that's not to say that some doctors don't make excellent administrators.
Physicians who chose to become administrators must go through a role shift.
"They must come to see themselves as a healer, but not a blood-and-guts healer," Gambescia said.