Trans­for­ma­tion of health­care requires physi­cian lead­ers steeped in busi­ness skills

Modern Healthcare - - COMMENT - Dr. Brian Don­ley

Imag­ine a busi­ness leader. Did you en­vi­sion a physi­cian? Prob­a­bly not. Doctors are ex­perts in their cho­sen med­i­cal field but aren’t con­ven­tion­ally thought of as pos­sess­ing man­age­ment lead­er­ship skills.

But that has been chang­ing, and among the pos­i­tive re­sults of this shift are bet­ter pa­tient out­comes.

Noted uni­ver­si­ties and in­ter­nal hospi­tal pro­grams—like ours at the Cleve­land Clinic—now have pro­grams to de­velop physi­cian lead­ers. This push is spurred by health­care trans­for­ma­tions, in­clud­ing the need to im­prove qual­ity of care, ac­cess to care and un­sus­tain­able costs. And the best way to in­still this ca­pa­bil­ity is to nur­ture high-per­form­ing teams led by physi­cians steeped in busi­ness skills.

We are mak­ing progress, but it’s not easy. Fo­cus­ing on a lead­er­ship mind­set and skill set in physi­cians is rad­i­cally dif­fer­ent from tra­di­tional train­ing meth­ods. To­day, we’re ask­ing physi­cians to lead col­lab­o­ra­tive care teams or­ga­nized holis­ti­cally around a pa­tient’s needs; plus, we need to be trans­par­ent in pub­licly shar­ing pa­tient-care per­for­mance. Thus, we ex­pect physi­cians to lead change, fos­ter team­work and en­cour­age per­sonal de­vel­op­ment—while main­tain­ing enor­mous clin­i­cal re­spon­si­bil­i­ties.

So dip­ping into the busi­ness man­age­ment bag of tricks makes sense. But we must re­dou­ble our ef­forts to lever­age busi­ness prin­ci­ples to trans­form U.S. health­care. De­mo­graphic shifts and the in­cred­i­ble ac­cel­er­a­tion of med­i­cal knowl­edge, data an­a­lyt­ics and tech­nol­ogy con­tinue to drive health­care spending to­ward 20% of GDP. The rise in mor­tal­ity from chronic dis­eases like Alzheimer’s adds to the bur­den. To­gether, these chal­lenges present the great­est op­por­tu­nity for physi­cian lead­er­ship in the his­tory of medicine.

But how best to op­ti­mize this process? In my ex­pe­ri­ence, physi­cians are best-equipped to en­gen­der bet­ter health­care by adopt­ing four guid­ing rules that will fos­ter their own lead­er­ship de­vel­op­ment:

In­no­va­tion. Physi­cian lead­ers must not only em­brace change, they must fuel it by im­ple­ment­ing cre­ative so­lu­tions for ef­fi­cient, ef­fec­tive care. Only by em­brac­ing a cul­ture of in­no­va­tion—and lead­er­ship by ex­am­ple— will they make it hap­pen.

Our med­i­cal cul­ture must en­cour­age and re­ward physi­cians to con­ceive and lead change, just as our busi­ness brethren do. I have seen it work at Cleve­land Clinic, which cul­ti­vates an en­tre­pre­neur­ial cul­ture by ex­pect­ing physi­cians to in­no­vate. When in­no­va­tion is in­cluded in per­for­mance met­rics, physi­cians won’t re­act to change—they will spear­head it.

Pa­tient ad­vo­cacy. Physi­cians must im­prove how we ad­vo­cate for pa­tients and com­mu­ni­ties to im­prove health. With changes in pay­ment mod­els, providers are bear­ing more risk for pa­tient and com­mu­nity health out­comes. This requires in­no­va­tive physi­cian lead­er­ship, as well as col­lab­o­ra­tion with all part­ners in the health­care ecosys­tem, in­clud­ing re­tail clin­ics, nurs­ing homes, gov­ern­ment agen­cies and so­cial ad­vo­cates.

Ad­vances in tech­nol­ogy and pre­dic­tive an­a­lyt­ics cer­tainly play a role. But the hu­man touch of care­givers will bring real progress to ame­lio­rate en­vi­ron­men­tal and so­cio-eco­nomic fac­tors af­fect­ing health. Cre­ative so­lu­tions are bol­ster­ing ac­cess to care, har­ness­ing com­mu­nity re­sources and im­prov­ing pa­tients’ well-be­ing and rigor in self-manag­ing their health.

Lis­ten­ing. Our pa­tients are a ter­rific source of good ad­vice on how to solve prob­lems. Care­fully lis­ten­ing to pa­tients can re-ori­ent health­care goals to achieve su­pe­rior clin­i­cal out­comes de­fined by pa­tients, not by hospi­tals and gov­ern­ment.

Physi­cians must ini­ti­ate this trans­for­ma­tion by ask­ing pa­tients a very sim­ple ques­tion: “How are you?” Lis­ten­ing closely to the an­swer re­veals the deep­est in­sights.

Ur­gency. Physi­cians must act now to achieve a fu­ture of his­toric change—higher qual­ity, bet­ter safety, and more af­ford­able and valu­able care. I be­lieve that physi­cians are up to this task. Imag­ine the trans­for­ma­tive progress we could make if all physi­cians were lead­ing ur­gently to re­de­fine U.S. health­care.

The most pow­er­ful health­care lead­ers are not the ex­ec­u­tives of hospi­tals, cor­po­ra­tions, gov­ern­ment agen­cies or politi­cians. They are ev­ery physi­cian sit­ting across from an equally allpow­er­ful force: the pa­tient. By em­brac­ing the tenets of busi­ness man­age­ment, physi­cians can—and must—lead the way to a brighter health­care fu­ture.

Dr. Brian Don­ley is chief of staff at Cleve­land Clinic

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