In their unique position bridging the C-suite and physicians, chief medical officers (CMOs) are charged most essentially with ensuring the quality of care delivered, and they have the potential to serve as agents of powerful change. But even when making meaningful strides in quality improvement is a shared goal among senior executives and clinicians, it has historically been a challenge for many CMOs and their organizations.  

This begs the question, how can CMOs successfully advance their organizations toward achieving this central goal? Valuable tools already at their disposal are healthcare ratings and rankings. With the right approach, CMOs can leverage ratings and rankings to improve quality and drive their organizations toward all-around stronger performance. 

The Right Approach to Improve Ratings, Rankings, and Quality: High Reliability 

Quality experts and leading healthcare organizations have noted that while ratings and rankings by reputable organizations aren’t perfect, external benchmarks like these are important tools for improving healthcare quality. 

“If you think about a Venn diagram between healthcare ratings and rankings and actual quality, we’ll all agree they don’t overlap 100%,” Andrew Resnick, MD, Chief Medical and Quality Officer at Chartis, said in a recent Becker’s webcast. “Yet that intersection is an essential focus for making meaningful strides in quality improvement.” 

And meaningful strides are undoubtedly needed. According to recent data from The Joint Commission, reported sentinel events have skyrocketed in recent years, with 2022 seeing a 78% increase from 2020. 

Citing the management maxim that you can’t improve what you can’t measure, leaders in the webcast pointed to the value of an external data source that’s married to internal measures and efforts.  

Many clinical leaders have wondered whether efforts to improve ratings and rankings can lead to actual clinical outcomes improvement—or whether improving ratings and rankings should simply be a byproduct of improving quality, safety, and reliability. 

Done right, working toward one should improve the other. It’s a bit of a chicken-and-egg scenario, said Dr. Resnick.  

But for CMOs who want to improve their organizations’ quality and safety performance, it can be a challenging time to undertake an additional effort. Major financial constraints and a workforce suffering from high rates of burnout, disengagement, and turnover have left many executives thinking they simply can’t add another improvement initiative to their organizations’ plates right now.  

That’s why an organization’s approach to improving quality performance is the key.  

Quality and safety improvement “can’t be ‘one more thing’” for your organization, said Michael Stadler, MD, Chief Medical Officer at Froedtert Hospital and Associate Dean for Clinical Affairs at Medical College of Wisconsin. “It needs to be the way you do things.”  

CMOs need to focus on building resilience to counteract the system-level and people-level errors that happen every day. The way to do that is to take a holistic approach—to become a highly reliable organization.  

Achieving high reliability should address not only quality and safety concerns but also help improve organizations’ many other pressing concerns. That includes the costs of care; inefficiencies; patient experience; liability exposure and expense; performance on regulatory surveys; reputation, ratings, and rankings; and staff engagement, retention, and wellbeing.  

In addition to improving outcomes for all patients, high reliability delivers a lower per-unit cost of care, Dr. Resnick said. “High reliability is the way to address all these things in a much more effective and efficient manner.” 

4 Key Elements for CMOs to Advance High Reliability 

As providers aim to become highly reliable organizations, experts point to several elements that are essential for success:  

1. Get Your People Onboard  

Depending on the organization, CMOs may need to first gain buy-in from their board, or they may have board-level support but need to fully engage the front line. Regardless, the main objective is to engage the entire organization—from top to bottom. 

2. Understand Your Methodology and Make It Your North Star 

Ratings and rankings can help support organizational goals and provide external benchmarks to work toward. But CMOs must recognize both their limitations and desired uses.  


Dr. Stadler noted that Froedtert was very deliberate in choosing a specific ratings and rankings system as its “True North,” based on the “sheer volume and objective nature of its measures.” He advises leaders to understand the methodologies they leverage and why they are prioritizing them over other methodologies. This includes distilling down representative measures to tell the story about the organization’s commitment to quality and safety.  

3. Empower and Align Your People 

The real key is to align the organization and make it accountable from the very top down to the front line and back up again to the board. The entire organization needs to know what the priorities are and be equipped to drive performance forward. CMOs are uniquely positioned to be able to connect at both the physician and executive levels.  

4. Communicate, Measure, and Close the Loop  

The best system is bidirectional, putting people in the right position of authority and accountability and fostering innovation. That includes clearly messaging how strategic and annual plans apply to quality and safety, elevating problems and innovations identified at the front line, confirming actions taken, and measuring results.  

Setting the Tone as the CMO 

It’s not easy to drive this kind of systemic change. But CMOs who equip themselves with the right skills as influencers and with key benchmark data can achieve meaningful improvements. That includes in the actual quality of the care their organization provides, in the recognition the organization receives through better ratings and rankings, and in supporting broader organizational goals through becoming a high reliability organization. 

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