Dr. Boris Larreta never wanted to head one of the largest hospitals in Southern California. Yet in January, he was elected to a two-year position as chief of staff for Providence St. Joseph Medical Center in Burbank. A cardiologist who has been at St. Joseph for his entire 19-year career, Larreta takes over a facility that, for the past several years, has been transitioning from a community-based hospital to a full-fledged regional medical center. In 2005, it opened a new 200,000-square-foot, 128-bed patient tower and last month broke ground on a new medical office building across Alameda Avenue. Plans are also in the works for a new cancer center nearby. The new structures will bring in thousands of new patients for the hospital, which means a considerable investment in human resources for administrators like Larreta, who is laying the groundwork for the hiring phase. Larreta sat down with the Business Journal to talk about the challenges of his new position, what he expects the hospital to deliver and what lies ahead for the Burbank medical center. Question: Tell me how a doctor becomes chief of staff. Answer: There are certain requirements. You have to have some experience with the medical staff and you have to have been a chair of a department, which I was: I was chair of the department of medicine, and I was the section chair for cardiology for three or four years. I was also director of the cath lab and I was a member of two committees. There’s a nominating committee and an election by the medical staff. Q: So it’s a very long process? A: Oh, yes. Q: Why did you want to become chief of staff? A: That was never really my desire; I was never really looking for that position. I was nominated by some of the physicians who were previous chiefs of staff. They recommended me and after talking with them, I thought I would give it a try. Q: Is it a two-year stint because you want to rotate different physicians in frequently? A: The general feeling is it takes six months to a year to become fully familiar with all of the committee processes and getting to know all the physicians who are involved. It’s a large hospital and it takes that long to become comfortable with the position. That was the principal reason behind it. Q: Walk me through what being chief of staff means. A: Basically, in any hospital setting, the medical staff is independent of the hospital administration. The physicians are basically responsible to cover themselves. The reason behind that is to minimize or prevent any conflict of interest between issues that would primarily benefit the hospital versus benefit the physicians. So we have structures. We’re divided into different departments and each department elects their own chairs. In addition to the departments, we have other committees. The chief of staff chairs the governing body that manages all of the physicians. There’s a committee of about 12 people; the COO is there and so are some other executives. We have monthly meetings and also go through ‘privileging,’ which is when a physician wants to come on staff. There’s a set of criteria, you have to check on all their credentials and it has to be approved by the medical executive committee. Q: And how large is that group that you’re managing? A: The medical staff is now more than 600 physicians. Not all physicians are here all the time. They might be physicians who work at other hospitals who spend a minimum time here. But I would say about 300 physicians use St. Joseph as a primary hospital. Q: What’s the biggest challenge for the chief of staff position? A: The biggest challenge is to try to keep up with all the regulations imposed on us and to try to maintain focus on the quality of care issues. Q: Do you think it’s especially difficult being a chief of staff in California? A: In general, I think the feeling is that there’s more regulation here versus anywhere else. But some of the regulatory issues aren’t negative. There’s been an increasing emphasis on hospitals monitoring their quality of care indicators. Every major area of care has quality of care indicators. We look at mobility, mortality, length of stay, complications, etc. We also deal a lot with the core measures. This deals a lot with, for example, medications. Everyone who enters the hospital with a heart attack is supposed to receive certain medications within a certain period of time. These are things that are decided based on medical research and evidence-based medicine. So one of the things we do is make sure the physicians are following those guidelines. And when they’re not, we look into why that hasn’t happened. So part of it is educational. Q: Is there anything unique about being chief of staff at St. Joseph? A: I think right now the growth of the hospital. Our census is up. Deliveries are up. Inpatient visits are up. We have a larger number of physicians joining our staff. Some of the challenges have to do with dealing with a large group of physicians and patients and making sure that everybody is providing the expected quality of care. Q: Is it easier to attract doctors and nurses with these new facilities? A: It has not been difficult. We have a huge number of physicians who are interested in becoming part of our staff. That poses some administration problems. The applications have to be processed and because of the numbers, there have been some delays and we hear complaints from physicians. But these are relatively minor problems. One of the other issues is the nursing shortage. There are many times when certain units in the hospital have to close because there aren’t enough nurses to provide adequate care. Q: And how are you addressing that shortage? A: Well, as chief of staff I deal directly with the chief nursing officers. But as physicians, one of the areas we can help is we have several levels of care we have intensive care units, we have step down units and we have regular beds and sometimes there might be patients that are stable enough to be transferred to a lower level of care. So we help to expedite that. Q: What are your goals over the next two years? A: To encourage the physicians to understand the importance of applying evidence-based medicine and to keep current with the latest medical knowledge, so we can improve our indicators of quality care. I think we’ve been very successful in that. SNAPSHOT – Dr. Boris Larreta Title: Chief of Staff, Providence St. Joseph Medical Center Age: 53 Education: B.A., University of California San Diego; M.A., University of Minnesota; M.D., University of Southern California Personal: Married with two children; lives in Burbank. Most Admired Person(s): My husband Jim and Isaac Asimov Favorite Saying: You can’t take back the last second of what you say, so you can’t worry about it.