Today, Weill Cornell Imaging at NewYork-Presbyterian’s radiology consultation service is a much-used resource among Weill Cornell Medicine physicians. But little more than a decade ago, this program—in which imaging experts provide real-time imaging ordering assistance and oncology-related consultations—was just a back-of-the-envelope idea that Dr. Keith Hentel (M.D. ’98) hoped to explore.
Now executive vice chair in the Department of Radiology at Weill Cornell Medicine and vice-president of Weill Cornell Imaging at NewYork-Presbyterian, Dr. Hentel designed and implemented the radiology consultation service for his capstone project of the Healthcare Leadership Fellows program inaugural class in 2012-2013.
“The program was instrumental in my efforts to implement a novel paradigm of care at our institution,” Dr. Hentel said. “Certainly, the time and formal education that the fellowship provided were helpful. However, the access to and mentoring from the top leaders at our organization was just as valuable to me. Without this program it would be hard to imagine that this care transformation effort would have succeeded, let alone provided more than 40,000 consultations to patients and providers over the past decade. Personally, my career has benefited tremendously from both the fellowship year and the network of leaders that the fellowship has created and continues to add to with each class.”
For more than a decade, the Healthcare Leadership Fellows program has prepared Weill Cornell Medicine faculty members to grow into institutional leaders. The competitive program provides funds to support leadership training and educational opportunities for fellows. It also provides individual mentoring, small group meetings with nationally known leaders and networking opportunities with current and past fellows. The program’s centerpiece is the design and execution of a project that explores an innovative solution for efficient, patient-centered and cost-effective health care delivery.
“Many of my most heavily relied-upon leaders—like Keith—have gone through this program, so I’m a big fan,” said Dr. Robert J. Min (M.D. ’90), president & CEO of the Weill Cornell Physician Organization, chair of radiology at Weill Cornell Medicine and president of Weill Cornell Imaging at NewYork-Presbyterian. “The radiology consultation service—now well accepted in the national radiology community but at the time almost unknown—measurably improves our clinical care and grew directly out of the Healthcare Leadership Fellows program.”
Projects Improve Care, Cut Costs
Program co-founder, newly retired Weill Cornell Medicine cardiologist and senior health policy advisor Dr. Michael J. Wolk, says that Dr. Hentel’s project met all the criteria for an outstanding capstone project: “We look for carefully defined projects that improve the quality of care, lower the cost of care, or both,” he said. “What’s more, projects must earn buy-in from key leaders at the institution and they must show measurable progress quickly, since the program covers just one year.”
According to Dr. Wolk, whose eponymous foundation has provided major funding for the program since its earliest days, the failed health reform efforts of the 1990s and early 2000s provided inspiration. “We saw that the biggest deficit in health-care reform was a lack of physician leadership on the national stage,” he said. “Now, developing new physician leaders is even more important as value-based care and population health continue to create ongoing changes in how health care is delivered, organized and paid for.”
In addition to the capstone project, leadership training and mentorship compose the heart of the program. Fellows select and attend one or two executive leadership short courses at outstanding external institutions like Harvard Business School. Fellows receive mentorship from a designated member of the Fellowship Committee, plus they also recruit a mentor to guide them throughout the year during monthly meetings as they refine and execute their project.
To date, 80 fellows have completed the program since its 2012 launch. “What the fellows have accomplished collectively has benefited Weill Cornell Medicine in unbelievable ways,” Dr. Wolk said. “At least 50 to 60 percent of former fellows have assumed significant leadership roles here at the institution, whether they’re committee chairs, quality chairs, managed care chairs, coordination of care chairs or the like. The program is doing exactly what we hoped it would.”
Interested junior faculty members, including non-physicians, complete an application that includes a project proposal and their department chair’s signature, attesting that successful applicants will receive a 10 percent release from their work responsibilities during the fellowship. Once the year’s six fellows are chosen in March, they must work with their mentor to refine the capstone project before the start of the fellowship year each June.
Bringing ERAS to Gynecologic Oncology
“I didn’t have a project in mind when I first approached the committee, but wanted to participate because I was feeling a bit siloed and it seemed a great opportunity to meet like-minded people from other departments,” said Dr. Kevin Holcomb, fellowship class of 2016-2017 and now vice-chair of gynecology in the Department of Obstetrics and Gynecology and associate dean of admissions at Weill Cornell Medicine. “As it turned out, the committee saw my potential and selected me, but they rejected my initial project idea.”
Dr. Holcomb persevered and eventually designed and implemented an enhanced recovery after surgery (ERAS) program for gynecologic oncology patients that examined evidence-based interventions and measured patient outcomes. “After consulting with my mentors on which endpoints to select for study, we ultimately were able to significantly reduce patients’ average pain score, the amount of time they remained in the recovery room and their postoperative opioid use,” he said.
Today, what stands out for Dr. Holcomb is the process more than the project itself. “The program got me out of my silo and into building consensus with others, both inside and outside of my department,” he said. “Meeting people who focused on improving outcomes and knew how to define metrics changed my outlook and impacted my work as associate dean of admissions. I'm able to define key performance indicators and metrics in ways that I don't think I would have without that experience.”
As far as Dr. Min is concerned, that’s exactly what the program should do. “There's a lot of things that go into being a successful leader, and we could all sit in a room and brainstorm about everything we want to fix,” he said. “But when you're given a certain project and a certain scope and certain resources, can you deliver on that? That’s what the Healthcare Leadership Fellows show they can do.”
ED Rounds for Quality and Safety
For Dr. Brenna Farmer, Healthcare Leadership Fellows class of 2015-2016 and now chief of emergency medicine at NewYork-Presbyterian Brooklyn Methodist Hospital, the program confirmed that she was a good fit for leadership. “Before the program, I was so immersed in frontline clinical work that it was hard for me to even figure out how a leader actually got things done,” she said. “But I knew I wanted to learn.”
At the time, the Department of Emergency Medicine was refining how they conducted routine evaluations of the emergency department to make sure that health care staff had what they needed to do their jobs effectively, a process known as leadership rounding. That gave Dr. Farmer the idea of breaking off a small piece of the larger project to make her own. “After learning about quality and patient safety rounding, I decided that’s where I would focus my efforts,” she said.
With a dual focus on human factors and patient safety, Dr. Farmer’s shorthand for discussing the project with colleagues soon evolved to, “What’s interfering with your ability to care for your patients the way you think you should?” she said.
That meant examining seemingly small details like where equipment was located within the department: “Why do I have to walk across the department to access this cabinet when it could be right at the bedside?” she said, adding that safety issues like the location of sharps containers also received scrutiny.
Dr. Farmer considers her participation in the Healthcare Leadership Fellows program to be a turning point in her career. “It ignited a feeling of needing to get more mentoring and coaching to decode the path to leadership in my department and the hospital,” she said. “It also crystallized in me the realization that I can affect more patients by improving the system than by remaining solely focused on patient care. Now it’s gratifying to go to the bedside and realize what I’ve done to be able to improve care for that patient and all others.”
And that, for Dr. Wolk, is the program’s enduring legacy.
“Our fellows play a critical role in the future of health care delivery at Weill Cornell Medicine,” Dr. Wolk said, “and investing in their leadership has been extremely rewarding.”