1. Scripps Health's dual CMO-COO role

At Scripps Health, Ghazala Sharieff holds an unusual position: a dual role as chief medical and operations officer. The dual CMO-COO role was developed over time as Sharieff took on more responsibilities at the health system.

Initially, Sharieff was CMO at Scripps, where there was no COO position. During the pandemic, her role as CMO expanded to include the COVID-19 command center and cyberattack response. Later, after Scripps' CFO retired, Sharieff became responsible for support services, which include food, environmental services, engineering, disaster management, and security.

"In an unexpected honor, the leaders of those teams actually went to our CEO and asked to report to me directly," Sharieff said. "That's unusual for a CMO—I had no engineering experience—but Chris [the CEO] agreed to the structure, and I took on those areas. I made it a point to learn everything I could."

Since then, Sharieff's role has continued to expand, eventually leading to her oversee five hospitals. To reflect her mix of responsibilities, Scripps gave her the new title of chief medical and operations officer.

According to Sharieff, one advantage of the CMO-COO role is more streamlined communication and decision-making.

"With this new leadership structure, change happens faster than ever," she said. "Communication is seamless, and we can prioritize projects based on real-time system needs—like deciding whether to build a new cath lab in the south or allocate resources elsewhere."

Although overseeing so many departments can be complicated, Sharieff said "open communication prevents delays and misalignment." She also requests that her team keep her up to date on all critical matters so that she's not surprised by any problems.

For organizations interested in creating a dual C-suite role, Sharieff said that "[o]pen communication is non-negotiable."

"I've promised my team that I have their backs if they have mine, and that's built a culture of trust and responsiveness. Being accessible and responsive is key," she said. "Also, leaders should be willing to hear pushback. My team isn't afraid to challenge me, and that back-and-forth is critical for strong decision-making."

2. Novant Health's regional leadership structure

To boost its expansion efforts across the Southeast, Novant Health recently announced a new regional leadership structure. Currently, the health system has Charlotte, Triad, Coastal, and South Carolina regions that each report to their own president. New regions will be named as the health system continues to grow.

Novant Health will also have acute and ambulatory operating units that work across its different regions. The health system also plans to further integrate Novant Health Enterprises, a business incubator originally launched in 2022, across the organization. 

CPOs can also help health systems:

• Navigate increasing costs and complexity of newer treatments
• Lead and shape strategy to address cost, realize revenue and margin potential, and improve value-based care for patients
• Optimize medication therapy management through collaboration with providers and staff
• Grow revenue through an improved specialty pharmacy strategy

4. Health systems reducing non-clinical positions

As health systems continue to face financial challenges, many are restructuring their organizations to cut administrative and management jobs. Cutting non-clinical roles can help organizations quickly reduce costs, increase efficiency, and avoid changing patient-facing staff.

Some health systems that have recently announced non-clinical layoffs include Mass General Brigham, Corewell Health, and Baystate Health. Some organizations have also cut leadership positions to reduce their layers of management.

According to Modern Healthcare, advancements in technology, including automation and artificial intelligence, have also made non-clinical positions more vulnerable to potential cuts.

Although there may be quick financial benefits to cutting non-clinical roles, analysts say that there is also a point where cutting jobs starts to negatively impact an organization.

"I do think there's a delicate balance of managing how deep you can cut in any function," said Rick Kes, healthcare senior analyst at the consulting firm RSM.

Why providers are rethinking their leadership needs 

By Sasha Preble, VP, Provider Strategy Practice Lead, Optum Advisory

Amid ongoing challenges in the healthcare industry, many providers are rethinking their decision-making and operating structures. The confluence of these challenges — not the least of which are volatility, uncertainty, rising costs, and tempered reimbursement — are pushing health system leaders to:

1. Enable clinicians to be more accountable for operating performance

Physician participation, and more specifically leadership, has led to improved adoption of initiatives, improved satisfaction, and better overall performance. Scripps Health creating a dual CMO-COO role demonstrates that physician leadership in day-to-day operations of a health system can be valuable.

This dual role also demonstrates the integration of clinical and non-clinical workflows, activities, and outcomes. Outside of operations, physician leaders have also taken on roles including executive leadership (CEO), medical group, and informatics (CMIO) positions (just to name a few).

The intersectionality of clinical and administrative leadership roles helps organizations make closer connections between business objectives and how they are practically achieved. These roles can better influence change and improve performance. When the roles are reinforced by a culture of transparency and trust, real change is possible.

2. Streamline performance as more integrated systems

The concept of "systemness" is not new. Businesses experience waves of centralization and decentralization over time. Right now, health system leaders are evaluating the best ways to organize their leadership and operations to ensure:

• Accountability to results
• Streamlined decision-making
• Alignment with system-level vision, strategy, and culture

Health system leaders should revisit their governance structures to decide what level of centralization vs. decentralization will allow their organizations to thrive in their respective markets. Doing so will create comparative advantage, drive growth for scale (not just size), and create compelling value propositions for patients, providers, and purchasers.

3. Acknowledge the importance of different revenue streams and adjust leadership teams to reflect

Now more than ever, providers are looking for ways to boost their revenue streams, whether through organic (or inorganic) growth in their care delivery models, commercialization of products/services/intellectual capital, or taking advantage of key parts of the value stream.

As health systems consider the expertise and leadership needed to grow in a competitive and challenging environment, leaning into the value of pharmacy can help providers better connect with opportunities, manage costs, and lead through change. Creating new leadership roles in this space can enable the oversight and thought leadership to intentionally create additional revenue streams.

4. Make challenging decisions to refine staffing needs

In an ever-difficult operating environment, health system leaders often need to make challenging decisions to refine their approach to staffing and support profitable operations. Although staff shortages exist in key clinical and non-clinical environments alike, leaders are forced to making difficult decisions to realign their expense base to meet compressed reimbursement.

No decision in this area is easy — all choices are hard. Now is the time for leaders to revisit:

• What the work is
• What skills are required to do the work
• How to do that work efficiently, using the tools at your disposal
• What teams you need to achieve your aims