When Bruce Hagen became president of Riverside Methodist Hospital in 2003, he had three prerequisites in mind for his senior team: physicians, physicians and more physicians.
About one-third of the 13 members of the senior management team at the 794-bed hospital in Columbus, Ohio, are physicians. Doctors hold the positions of chief medical officer and vice president of quality and clinical support; the team also includes two leaders from the medical staff.
Hagen had good reason for surrounding himself with physicians. "We have been through quite a bit of turmoil in terms of the relationship between the hospital and the medical staff and we were coming off of that at the time I arrived," Hagen says. Riverside is the flagship hospital of OhioHealth Corp., which owns seven hospitals and is affiliated with six others. There were a multitude of tensions between the administration and the medical staff, including operational problems in the surgical suites, physician mistrust of OhioHealth management and angst over cost-cutting decisions. A feud between OhioHealth and physician investors in a competing specialty hospital added to the conflicts.
After the relationship had reached a boiling point, the medical staff hired its own consultant to design a way for the medical staff to regain its influence over management decisions at Riverside. The consultant recommended a series of clinical operating councils organized around practice areas and populated with physician leaders, nursing managers and others.
When Hagen arrived, the councils were just getting organized. "I embraced it, encouraged it, and pressed hard on the administrative folks to be actively involved," Hagen says. He had been hired as the chief operating officer of Riverside, the top job when he arrived, but became president within months of being hired. The change in title was part of a reorganization of OhioHealth.
Hagen believed it was equally important for physicians to be a part of the senior leadership. In January 2004, he hired the hospital's first chief medical officer.
"I thought I needed to have someone with a lot of credibility and lot of integrity -- someone who was a known entity -- so I was just looking internally," Hagen says.
To find the right person, he set up a search committee comprising six past presidents of the medical staff. While Hagen made clear that "this was my hire," the choice was unanimous: Marshall Vary, vice president of behavioral health services at Riverside and two other OhioHealth hospitals.
In June 2004, Hagen announced the appointment of another well-respected physician, Stephen Markovich, as vice president of quality and clinical support. Markovich was promoted from associate medical director at Riverside. "He knew the place inside and out and he had a great relationship with physicians," Hagen says.
While a spirit of teamwork has emerged, Hagen describes the relationship between the medical staff and hospital management as "fragile." Adds Hagen, "I don't want to do anything that is going to be contrary to that progress."