Your Path to Program Success: Expert Advice

Investments in Leadership: The Value of Interim Management to the Cardiac Cath Lab

Ross Swanson, Vice President, Corazon, Inc., Pittsburgh, Pennsylvania
Ross Swanson, Vice President, Corazon, Inc., Pittsburgh, Pennsylvania
Most hospital hospital leaders appreciate the difficulty in recruiting and retaining talented individuals to lead their cardiovascular programs. It is particularly difficult to find leaders for specialty areas such as the cardiac catheterization lab. What is surprising is how many key positions in this specialty remain vacant for months, or even years, as hospitals attempt to find that perfect match! In the cath lab setting, leadership and management vacancies can have a significant impact on overall operations because of the complexities associated with procedural scheduling, patient clinical management and supply/inventory management. There are multiple areas in the cath lab that can go awry without the proper management oversight. In fact, we have noted that many times the cath lab manager is the “glue” that maintains continual communications between several interventional cardiologists and/or cardiology practices. One of the reasons that a cardiologist may choose to perform their procedures within a particular cath lab can often be directly traced to the manager. When we ask our clientele why such a valuable position has been vacant for so long, answers vary. The most common responses include: a lack of qualified applicants and/or the reassignment (and increased number) of duties for those individuals already working in the lab. These responses are slightly unsettling because heart and vascular services can represent up to 40% of a hospital’s total revenue. On the other hand, heart and vascular expenses can be the highest in the cath lab procedural setting. When they are unmanaged, significant problems can occur related to the number of supplies per case, physician preference items, vendor influence and the cost of high-end implantables. Furthermore, a diagnostic and interventional cardiac cath lab typically experiences one of the highest volumes of patients seeking cardiac healthcare for urgent reasons when compared to other hospital departments. The nature of urgent cases warrants special attention, as deviation from standardized procedures and protocols can have a serious impact on patient outcomes. In fact, it is often the cath lab manager who would be charged with department-level interventions to positively impact quality measures such as the door-to-balloon (DTB) time. Can your program afford to have a clinical area — especially one as critical as the cath lab — remain ‘leaderless’ for any period of time? We believe that a leadership vacancy even as short as a few weeks can have profound negative impacts on your cardiac cath program. If your hospital currently lacks leadership in any key cardiac and/or vascular area, ask yourself the following: • Are we taking a reactive (versus proactive) approach to ensuring that this crucial program is remaining financially and operationally viable, and also sustaining growth? • Have we lacked leadership in this area for longer than three months? • Are the “front-line” workers within this service expressing dissatisfaction to senior management? If you answered yes to any of these questions, one solution may be using an interim manager to guide your program until PERMANENT leadership can be found. Effective leadership, particularly within the cardiac cath lab, is critical to program growth and success; but, any gap in management can cause a loss of direction, leading to slowed momentum and growth, decreased morale, and/or increased costs. The cardiac cath lab has many operational complexities that require strong leadership control at all times. Very few departments in the hospital deal with the variable amount of on-call responsibility, complexity of scheduling and emergent patient issues compared to the cath lab. Often times these operational concerns cannot be managed solely among the staff without someone at the management helm to point operations in the right direction. Positions within cardiovascular services offer great opportunity for career growth and development, especially since programs across the country are expanding, technology and practices are advancing, and there is a shortage of qualified candidates to fill these emerging roles. No program can thrive long without a permanent, dedicated leader, but, industry trends reveal that an interim expert can position a program for success while searching for that ‘perfect fit.’ Interim managers can bring vast benefits to a cardiac cath lab if needed. For instance, an interim leader can help to identify opportunities for the heart and vascular program, as well as bring new perspective and energy. A new point of view can often highlight clinical or operational issues, and have unbiased solutions for such challenges. Cardiologists have taken well to interim managers, as they now have a single “go-to” person for problems or feedback related to the cath lab department. The positive return on investment related to using interim management can be different at every organization. For instance, at one client site, a Corazon Interim Manager instituted changes related to coding and documentation that are projected to bring in an additional one million dollars of revenue for non-invasive cardiology. At another, Corazon’s interim manager increased staff morale through teambuilding programs, and turnover rates dropped by half over a six-month period. The true value of an interim manager can be estimated by taking the tangible dollars estimated to be due to a leaderless program and adding them to the intangible program impact, as detailed in Table 1. One of the most requested services of Corazon’s Management Resources division is from hospitals that are looking to bridge the gap for leaderless cath labs. We have supported cath labs that have turned to an interim solution because of the negative impacts such as very poor procedural coding practices or high staff turnover. Hospitals will often bring in an interim manager for an area such as the cath lab with the anticipation of a short need (less than 3-6 months), though often they will continue to request an extension to the interim engagement because the manager has created such a positive impact in a short time. Overall, an interim leader can bring a unique management perspective to a program, using an unbiased viewpoint that can be the catalyst for positive change. Using an interim leader in a key position can ensure that both strategic planning and operations management will continue so the program won’t miss a beat — important strategic initiatives and operational tasks can continue forward with the interim leader providing stability and mentorship. Ross Swanson can be contacted at