EVIDENCE BASEDINSIGHT
Country Medical Directors: Leadership in Nephrology
September 21, 2020 Ģý 4 min read
Country medical directors (CMDs) are key members of the Global Medical Officeleadership team. Their role is multifaceted and includes managing clinical servicedelivery and the complexities of local regulations, coordinating and implementingglobal healthcare strategies on a country-wide level, and recognizing newopportunities to improve patient care. CMDs also play a vital role in representingthe patient-focused values of Ģý and serving as the companyĢýs interface with local medical communities.
Healthcare systems worldwide are rapidly changing enterprises facing many challenges. The demand for,greater care coordination, and efficiency is balanced againstdelivering high-qualityfor chronically ill patientsacross societies and healthcare systems of varying maturity.With a care footprint spanning 150 countriesĢýeach with its ownunique challenges and regulatory and governmental frameworksĢýĢýĢýs Global Medical Office delivers agile,impactful medical leadership that drives success across this highlyvariable healthcare landscape.
As experts in the structure, nuances, and dynamics of the myriadhealthcare systems in which it operates, the companyĢýs countrymedical directors (CMDs) play a vital leadership role in managingthe medical complexities of patient care at the local and regionallevels. In ĢýĢýs Europe, Middle East, and Africa(FMC-EMEA) region, the CMDs are responsible for the countrybasedclinical strategy, decisions, and new medical opportunities.
ճnetwork is the clinical footprint in FMC-EMEAincluding more than 790 clinics and is coordinated by 28 dedicatedphysicians across 29 countries that make up the EMEA region(Figure 1).
FIGURE 1|Ģý's EMEA region includes 29 countries with 28 physicians appointed as country medical directors
The leadership structure of the Global Medical Office providesoptimal global medical and clinical oversight by addressinguniversal issues in chronic disease care at the global level, whilemanaging the complexities and diverse regulatory requirementsof markets at the country and local levels (Figure 2). Thisfosters both local and global progress. With the evolution ofprecision medicine, integrated patient data collection, precisedialysis treatment prescription through diagnostic tailoring,genomics, integrated artificial intelligence, machine learning,and care delivery standardization, CMDs lead the country-levelopportunities to improve patient care while playing an importantrole in enabling care coordination across the Fresenius MedicalCare network at a global level.
FIGURE 2|The Global Medical Office leadership structure
The functional community of CMDs in FMC-EMEA is supervisedby the EMEA chief clinical officer, improving the effectiveness andefficiency of the companyĢýs NephroCare dialysis clinics throughoutthe region while reducing variations in clinical practice.
The CMDs provide scientific-medical support and guidance innephrology and dialysis to all areas of the company. In theirrespective countries, they organize medical meetings, medicaltraining, and education to healthcare professionals within andoutside the NephroCare clinic network, in cooperation with thecorresponding departments at the EMEA head office. By providingscientific-medical support, CMDs are the key interface to the localmedical community. The role of the EMEA CMDs has expandedover time to include clinical service leadership, management andmentorship, coordination and communication, and reporting anddocumentation (Figure 3). Their responsibilities include:
FIGURE 3| Role of the CMDs in EMEA
- Managing the local dissemination and implementation ofcorporate strategic medical projects and outcomes-basedstandards of safety and patient care
- Overseeing and leading the medical processes and clinicalgovernance of NephroCare dialysis clinics
- Supervising population management and the implementationof patient care standards, addressing treatment incidents, andcomplying with legal and regulatory guidelines
- Supervising and monitoring patient care quality performancedelivered by all NephroCare dialysis centers, and settingmedical quality targets (including targets for cost elementsrelated to medical objectives) in agreement with the EMEAchief clinical officer
- Pursuing new medical opportunities of value to the region incoordination with the companyĢýs Global Medical Office
CMDs also play an important role in managing the local medicaldirectors within a specific country, supporting the recruitmentprocesses for medical directors and physicians, and collaboratingwith human resources and NephroCare operations managersto define medical director and clinic staff responsibilities. Thispart of the CMD role requires leadership and engagementskills to foster and reinforce ĢýĢýs values ofcontinuous quality improvement and clinical effectiveness and aculture of excellence.
In each country in the EMEA region, the clinic staff iscontinuously challenged to implement both evolving and newtreatment prescriptions, complex medication regimens, andnew dialysis techniques, as well as individualized fluid statusto reduce the intradialytic hypotensive episodes and long-termuremic cardiovascular complications. CMDs help determine howthese innovations can be implemented at the local level whilemaintaining focus on key global objectives.
Physician leadership across the Global Medical Office hasplayed a vital role in advancing ĢýĢýs globalcredibility while fostering a culture of compliance. Physiciansare increasingly taking management positions in healthcareorganizations where they are expected to be skilled in leadingstaff, care teams, and community initiatives. A paper publishedinSocial Science & Medicineexamined strategic governance inthe United KingdomĢýs National Health Service (NHS) hospitaltrusts and found a significant and positive association between ahigher percentage of clinicians on boards and the quality ratingsof service providers.1Physicians have the highest influence whenit comes to implementing operational changes that can leadto improved performance.2,3A study published inHealth CareManagement Reviewreported that large hospital systems led byphysicians in 2015 received higherU.S. News and World Reportquality ratings, performed better financially, and operated moreefficiently than those led by non-physician managers.4
Ongoing listening and learning are key to the companyĢýs successin meeting the needs of chronically ill patients around theworld. By investing in its medical directors, Fresenius MedicalCare applies their collective ingenuity and sophisticatedunderstandings of regional and country health dynamics tolead the way in developing value-based care models that areresponsive to global complexities.
The Global Medical Office at Ģý has identified five focus areas of social determinants of health that directly relate to the functional status of with ESKD
ANNUAL SYMPOSIUM DEMONSTRATES COMMITMENT TO LEARNING ACROSS EUROPE, MIDDLE EAST, AND AFRICA
Veteran nephrologist Stefano Stuard, MD, PhD, is chief clinical officer of ĢýĢýs Europe, Middle East, and Africa NephroCare network of dialysis clinics. As part of the regionĢýs commitment to lifelong learning and development for medical directors and physicians, a country medical directors symposium is held annually to review the latest developments in chronic kidney disease care. Although it is a company event, the scientific merits of the symposium have earned the meeting accreditation by the Union Européenne des Médecins Spécialistes, which awards continuing medical education credits to attendees. The meeting is also endorsed by the European Renal Association-European Dialysis and Transplant Association as a scientific meeting.
Stefano Stuard, MD, PhD, Chief Clinical Officer for Europe, Middle East, and Africa region, welcomes participants to the annual Ģý EMEA symposium.
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References
- Veronesi G, Kirkpatrick I, Vallascas F. Clinicians on the board: what difference does it make?Soc Sci Med2013;77:147-55.
- Hamilton P, Spurgeon P, Clark J, et al. Engaging doctors: can doctors influence organisational performance? NHS Institute for Innovation and Improvement, July 2008. https://www.fmlm.ac.uk/sites/default/files/content/resources/attachments/
49794%20Engaging%20Doctors%20-%20Can%20doctors%20 influence%20organisational%20performance.pdf. Accessed June 30, 2020.
- Dickinson H, Ham C. Engaging doctors in leadership: review of the literature. NHS Institute for Innovation and Improvement, January 2008. https://www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/research/leadership-literature-review.pdf. Accessed June 30, 2020.
- Tasi MC, Keswani A, Bozic KJ. Does physician leadership affect hospital quality, operational efficiency, and financial performance?Health Care Manage Rev2019;44(3):256-62.