CQO role offers broad leadership challenges. (Leading Questions).

Some assume that leadership is exclusively the job of the chief executive officer, the individual at the top of the organization. Of course, that's not true--leadership is a vital component for many other senior clinical and management roles.

Without strong leaders in finance and information services, for example, most organizations would falter. For physician executives, a position has emerged in the past few years that may be tailor-made for their leadership--the chief quality officer (CQO).

Unfortunately, the CQO role in some quarters acquires an undeserved reputation as a career sidetrack. Perhaps it's been designed as a pre-retirement "perk" for a worthy, if slowing-down, physician.

In that case, the CQO role will be largely ceremonial, with little genuine ability to impact organizational quality. But those positions should not cloud your perspective on the real challenge represented by the role of the CQO in today's pre-eminent health care organizations.

When established and supported properly, it's a vital and invigorating position with no wasted time or talent. Optimally, the CQO role calls upon every bit of a physician executive's experience and abilities--and even can stretch some previously unexercised executive muscles.

Broad in scope and far-reaching in its power, a CQO position can truly be an ideal career goal for the skilled physician executive. In the interest of full disclosure, I was once myself a CQO in a hospital system. It was an interesting time.

Primary CQO skills

Based on what health care organizations demand of CQO candidates these days, I believe a successful CQO must possess these five key skills:

1) Leadership of change management

This is a job for an individual who wants to wake up the organization. No more "same old, same old." No tolerance for errors and their consequences for patient safety. A great CQO has a passion for improvement, does not revere the status quo, understands the essential linkage between financial performance and quality care, admires efficiency and can communicate a broad vision of a better future to others, at every level of the organization.

2) Ability to change physicians' performance and behavior

Physicians have enormous clout and it requires a great deal of work and skill to convince them to change. They're not natural team players and must learn to see the importance of the process of quality, not just for individual procedures but for every procedure. And, yes, before they accept changes for quality physicians may claim: "But my patients are sicker!" Despite their best efforts at resistance, an effective CQO will generally be able to motivate physicians' behaviors and manage their concerns.

3) Knowledge of the organization's processes

Because the CQO understands the modern--and extremely complicated--health care facility, he or she knows where the problems are and can effectively root out waste and error, whether in medical errors or in nursing service or pharmacy practices. In my own work as GQO, for example, we determined that only about 33 percent of C-section patients were receiving antibiotics--because there were a crushing 22 steps to take between the decision and administration of the drugs. After changes were made, 95 percent of the C-section patients received their antibiotics in a timely manner. Similarly, by stocking antibiotics on the floor of the emergency room and having registered nurses administer the drugs, we reduced a lengthy wait for pneumonia patients.

4) Ability to collect and analyze data, and communicate findings

The CQO converts data to useful information to help identify areas for quality enhancement. This is not done in a technical, "robocop" way because this is much more than epidemiological and biostatistical tinkering. The CQO must understand how to extract data, conduct appropriate analysis, develop an operational plan and sell ideas. The CQO should regularly meet with the CEO and the board, and be able to use data to communicate concepts of change.

5) Understand and be able to implement "Crossing the Quality Chasm"

Some CQOs lead from previously developed templates, such as the Baldrige Award criteria or from the Institute of Medicine's, "Crossing the Quality Chasm: A New Healthcare System for the 21st Century." These established objectives appear to be ideally suited for physician executive leadership. Whether or not you will ever be a candidate for a CQO position, reviewing these reports will provide a stimulating charge. The ability to implement the six hallmarks of quality care listed in the TOM report is frequently discussed prior to making a hiring decision for a new CQO. Top CQOs have practical ideas of how to implement positive change, to ensure that health care is safe, effective, patient-centered, timely, efficient and equitable.

What to consider in the CQO role

Some organizations tap non-physician general administrators for the CQO role. Of course, the focus of the job depends on the organization's goals. If they want to run a "data shop," then they usually don't want a physician executive. They also probably don't want a leader, either.

But if they want to make a positive quality impact in every area, then they're more likely to seek a physician with management ability to lead their CQO efforts. This is the kind of organization whose board and CEO consider quality to be the primary goal, "Job 1." They don't seek cosmetic changes or touch-ups but look instead for an exponential growth in quality care now and in the future.

If you're ever approached about a CQO position, I hope you'll consider the leadership challenge and take the opportunity seriously when it arises. Here are some key "wheat/chaff" questions to ask when you look at any CQO role for a possible career move. They'll help to clarify the challenges and opportunities:

* Why was the position developed? Was it created for the right reasons? Do they want an energetic leader or are they looking for a timeserver?

* Who or what is driving the position? If it turns out to be nothing more than a compliance response to a Joint Commission on Accreditation of Health Care Organizations audit, then step away and don't look back.

* To whom does it report? Reporting to the CMO will give the position an entirely different focus (generally more limited in scope) than reporting to the CEO. Be aware of the subtleties and ask questions.

* Does the job have regular board access? If it doesn't and the board doesn't want frequent contact, you can assume little real power and ability to move the organization will be associated with the role.

* What support is available and budgeted? An effective CQO needs data and analysis staff support as well as an effective team to work with the medical finance and operations staff.

* What are the real objectives for the CQO? Look at the tasks assigned in the position description as a guide. Assess how broad or narrow the role will be and then how well it fits with your own background and abilities. Don't try to fold yourself into a small job if you're already too big for it. You really won't be happy.

Think it over...

In sum, there are some excellent leadership opportunities out there as CQOs for ambitious, inspired physician executives who want to make real change. Far from being a backwater or the road to nowhere in particular, the CQO position can be a real place to shine, a place where leading for results has a genuine impact throughout the organization.

RELATED ARTICLE: CQO Wanted

* Reports to executive vice president of the two-hospital, $1.5 billion ABC Health System

* Responsibility for leading development and implementation of comprehensive quality measurement and improvement programs

* Responsibility for developing and implementing a vision, strategic plan, measurement infrastructure and continuous improvement program

* Coordination of quality administrative activities, chairing the ABC Health Performance Improvement Council and CP/C

* Participation with the Operations Executive Council

* Collaboration with director of education in developing 'quality' training programs

* Provision of guidance to quality team members and leaders

* Maintenance of effective communication with medical staff

* Participation with members of management team

* Lead the introduction of new quality programs, techniques and concepts

* Champion and lead for quality, outcomes-driven, cost-effective and affordable health care at ABC System

Scott Ransom, DO, MBA, MPH, CPE, FACPE is vice president at Witt/Kieffer in Oak Brook, Ill, and president of the American College of Physician Executives. In addition, he serves as an associate professor in health management and policy at the University of Michigan and associate professor in obstetrics and gynecology at Wayne State University School of Medicine. He can he reached by phone at [phone] or by e-mail at [e-mail].