Performance Report: Critical Characteristics of High-performing Cardiology Programs—Start at the Top

This is the first of a two-part article on the critical characteristics of high-performing cardiology programs and service lines. Find the second part here. 

High-performing cardiology programs set the standard for patient care with respect to quality, resource utilization and patient as well as physician satisfaction. These are programs that live up to the mission statement and goals of the system to which they belong. It’s no coincidence that such high-performers tend to have a number of characteristics in common. Their attributes can be grouped into three broad areas: engagement of Board members and the C-suite team, coordinated leadership by physicians and top-level managers, and a culture that resonates throughout the organization. 

This two-part feature will analyze characteristics that I’ve found—as an interventional cardiologist working for 30 years in numerous systems, the director of a large community-based cardiovascular service line (CVSL) and the medical director of a national review organization—are critical for a cardiology program or service line’s success. In this first article, we focus on the responsibilities of the Board and C-suite team because great programs almost always can be tracked to individuals in these roles who created and executed an outstanding vision, thus providing an environment where the cardiovascular administrator and physician leaders have clear goals and responsibilities. 

1. Invested in CVSL strategic planning 

Strategic planning is a critical responsibility of the CVSL’s Board and C-suite. A high-performing cardiovascular program invests significant resources in developing a strategic plan specific to cardiovascular services. Importantly, the plan is in line with the health system’s goals and developed with (not for) their cardiovascular physicians. 

The CVSL’s strategic plan’s direction often is determined by whether the program is in consolidation or growth mode—a decision that should be made by the health system’s board in consultation with CVSL leaders. Once that choice is made, all stakeholders are included in the plan’s development, which often is led by an expert third-party facilitator. Once the plan is finalized, all cardiovascular clinicians and staff are briefed with an emphasis on the roles they will play in implementation. 

In high-performing programs, strategic planning is an ongoing process, where leaders routinely evaluate the program’s performance against benchmarks specified in the plan and address opportunities for improvement. These leaders understand that they will need to adjust in response to new and emerging developments, constantly monitor their system’s performance and attack underperformance promptly.

2. Engaged CEO & Board 

There is no substitute for a health system Board and CEO who actively support the efforts of the cardiovascular team. One way to get both Board members and the C-suite truly engaged is to earn their endorsement of the CVSL’s strategic plan. They should have a deep understanding of both the system’s strategic plan and have been engaged during the congruent development of the CVSL’s plan.

A Board’s endorsement of the CVSL’s strategic plan should be more than a rubber stamp. Rather, it is the Board members’ commitment to help the program achieve its goals through both resource allocation and thoughtful oversight. The Board should require regular updates on progress as well as changes to the plan and program. This includes oversight of major changes in the roles or responsibilities of any physicians, review of financial and clinical performance, and holding the program’s physician and non-physician leaders responsible to address why goals are not being met. 

3. Administrative support of data collection

In high-performing cardiology programs, administrators play a vital role in ensuring the service line’s vision and goals are understood, publicized, inspiring and actionable. Administrators often are the lynchpin between the C-suite and physicians. They recognize the need for objective analysis of the program’s strengths and weaknesses, and provide the tools necessary for identifying and addressing performance gaps, particularly around personnel issues, resource allocation and clerical support. 

The most effective programs are data driven, with effort and resources dedicated to collecting data that are specific, measurable, accurate, actionable, relevant and timely. This requires a culture of trust with active support for data collection and dissemination, resources for clerical and administrative staff, and financial support for physicians actively involved in the process. These programs have processes in place for analyzing the data, a system for recommending changes, an infrastructure for implementing such changes and a protocol for ongoing evaluation of the methodology. 

In high-performing systems, there also is ongoing structured dialogue between the physicians who provide care and the quality champions (both physicians and administrators) who analyze the data and develop quality improvement plans. They hold regular meetings where attendance is expected (sometimes required) and rewarded. 

4. Compensation aligned with strategy

High-performing programs recognize the wisdom in the oft-cited axiom “you get what you incent” and align compensation models for both physicians and administrators to meet the agreed-upon vision and strategy. To incent efforts beyond clinical production, they may institute bonuses or other tangible rewards, or implement quality holdbacks.  

Contracts are specifically designed to incentivize physicians and administrators to meet the system’s goals. The contracts can be individualized as needed and, when crafted thoughtfully, will create a positive work environment that fosters teamwork and productivity.

5. On board with value 

Highly effective programs have embraced the concept of value. Rather than resist the transition from volume to value, such programs have been leaders in the development of accountable care organizations, have participated in voluntary risk programs or have at least had Medicare review their programs for entry and acted to identify issues. Some have explored the Patient Centered Medical Home. All are aware of the data collected by the Centers for Medicare & Medicaid Services and contained in Medicare’s annual Quality and Resource Utilization Report. 

The best systems incorporate appropriateness of care, clinically defined outcomes, patients’ expected outcomes and resource utilization into any care path they design and implement. They recognize that the target for these measures may never be met as it is constantly evolving to higher levels.

6. Committed to research 

Clinical research is an important component of any outstanding system and, for many, a major priority. Research brings prestige and national stature, attracts and retains patients who might have sought care elsewhere, enhances physician satisfaction and generates significant revenue. If, however, resource or opportunity costs prohibit active clinical research, programs can demonstrate a similar commitment by sourcing the literature and implementing best practices that are aligned with current guidelines. 

Peter L. Duffy, MD, MMM, is an interventional cardiologist in North Carolina. He has served as medical director of the CVSL at Reid Heart Center/FirstHealth of the Carolinas and currently is chair of the Society for Cardiovascular Angiography and Interventions Cath Lab Survey Committee and a member of the American College of Cardiology Interventional Council and National Cardiovascular Data Registry Management Board.