‘Good peo­ple with high lev­els of ide­al­ism or al­tru­ism are get­ting frus­trated by the in­creas­ing com­plex­ity’

Modern Healthcare - - Q&A -

As pol­i­cy­mak­ers, providers and pay­ers con­tinue to tinker with al­ter­na­tives to an ail­ing fee-for-ser­vice de­liv­ery model, physi­cians are in­creas­ingly be­ing called upon to help lead the trans­for­ma­tion. Roughly 5% of hospi­tal lead­ers were physi­cians in 2014, ac­cord­ing to the Amer­i­can As­so­ci­a­tion for Physi­cian Lead­er­ship, and anec­do­tal ev­i­dence sug­gests that is ris­ing. Fre­quently, physi­cians are be­ing thrust into lead­er­ship roles with­out be­ing given the tools nec­es­sary to suc­ceed, said CEO Dr. Peter An­good. He re­cently spoke with Mod­ern Health­care Man­ag­ing Ed­i­tor Matthew We­in­stock. The fol­low­ing is an edited tran­script.

Mod­ern Health­care: How well-pre­pared are physi­cians to move into lead­er­ship roles within their or­ga­ni­za­tions?

Dr. Peter An­good: It’s vari­able. There are in­di­vid­u­als who proac­tively seek out some ad­di­tional ed­u­ca­tion, some knowl­edge and some ex­pe­ri­ence. There are ma­ture or­ga­ni­za­tions that also rec­og­nize if they are go­ing to re­ally lever­age the physi­cians’ ex­pe­ri­ence, they need to pro­vide them with the ad­di­tional knowl­edge and ex­pe­ri­ences and the skills to re­ally as­sume these roles.

How­ever, in the in­dus­try, both on the in­di­vid­ual and on the or­ga­ni­za­tional side, there’s an as­sump­tion that be­cause you are a suc­cess­ful physi­cian in your prac­tice and the com­mu­nity seems to highly re­gard you, that you will be a good leader. That isn’t al­ways the case. Yes, some suc­ceed by just pure raw tal­ent, but more of­ten than not, the com­plex­ity of our in­dus­try is such that you need added tal­ents. Un­for­tu­nately, those who just kind of trickle in or fall into those roles tend to fail or not suc­ceed as best as they could.

MH: What steps can an or­ga­ni­za­tion take to get their physi­cians ready? Where do they start?

An­good: If an or­ga­ni­za­tion un­der­stands it­self well enough that it wants to have physi­cians bet­ter en­gaged, in­te­grated and mov­ing into lead­er­ship roles, they should be tak­ing a hard look at what they are re­ally try­ing to ac­com­plish with those roles, iden­tify those needs and then start to tar­get in­di­vid­u­als who could po­ten­tially move into those roles. As they tar­get those in­di­vid­u­als, there also needs to be a stage of, “Do those in­di­vid­u­als re­ally have the ca­pa­bil­i­ties?”

So there are two lev­els of needs as­sess­ment: the or­ga­ni­za­tional one, and the iden­ti­fied lead­er­ship group of physi­cians and what are truly their ap­ti­tudes and ca­pa­bil­i­ties.

MH: How crit­i­cal is it for physi­cians to move into lead­er­ship roles now?

An­good: Health­care is an in­her­ently com­plex in­dus­try and is al­ways go­ing to be a com­plex in­dus­try. As new mod­els of care are brought into place, as new fi­nan­cial mod­els are put into place, it be­comes ev­i­dent that the physi­cians who are well-skilled clin­i­cally and have suc­cess­ful out­comes, when they are trained well with lead­er­ship and man­age­ment skills, that dual skill set re­ally winds up be­ing able to drive or­ga­ni­za­tions in a much more ef­fi­cient way to­ward qual­ity, safety, value and bet­ter out­comes over­all.

There is a trend in our in­dus­try that re­ally makes it ripe for physi­cians to pur­sue that type of a tra­jec­tory and also for the or­ga­ni­za­tions to rec­og­nize that if they get their physi­cians in­te­grated bet­ter into lead­er­ship roles, that or­ga­ni­za­tion will per­form bet­ter. Pa­tient out­comes will be bet­ter and their pa­tient sat­is­fac­tion will be­come bet­ter over­all.

MH: What kind of data have you seen to sug­gest that physi­cian-led or­ga­ni­za­tions are do­ing well with al­ter­na­tive pay­ment mod­els?

An­good: When you look crit­i­cally at data on ac­count­able care or­ga­ni­za­tions over the first few years, the bet­ter per­form­ing ACOs are physi­cian-led. They are the ones that are typ­i­cally

“In the in­dus­try . . . there’s an as­sump­tion that be­cause you are a suc­cess­ful physi­cian in your prac­tice and the com­mu­nity seems to highly re­gard you, that you will be a good leader. That isn’t al­ways the case.”

get­ting their ben­e­fits and their shared-sav­ings pay­ments. As well, when you look at some data where physi­cians are CEOs and com­pare their qual­ity data on es­tab­lished met­rics, there can be a 25% to 33% im­prove­ment in those qual­ity met­rics.

MH: What are you see­ing in ru­ral or smaller hos­pi­tals when it comes to en­gag­ing with physi­cian lead­ers?

An­good: We still have a high de­gree of vari­abil­ity in terms of the re­la­tion­ships be­tween the med­i­cal staff of the hospi­tal and ad­min­is­tra­tors. Where there is a healthy re­la­tion­ship be­tween the med­i­cal staff and the hospi­tal, then in those smaller places there is typ­i­cally good in­ter­per­sonal re­la­tion­ships as well.

What we see, and what I think works, is as a tran­si­tion step to evolve into the so-called dyad model, where you bring a non­clin­i­cal ad­min­is­tra­tive leader or the CEO to­gether with a clin­i­cal leader and then clar­ify what that re­la­tion­ship re­ally is and how they work in a syn­er­gis­tic way to re­ally make that place work bet­ter. The dyad mod­els that don’t do well are the ones where you just sort of say, “Well, let me do all this ad­min­is­tra­tive stuff as the CEO, and you just go do all that pa­tient stuff.”

For or­ga­ni­za­tions that may not have as healthy a re­la­tion­ship be­tween the med­i­cal staff and the ad­min­is­tra­tive lead­er­ship, the first step is to de­ter­mine how to help get a bet­ter re­la­tion­ship go­ing. There might be a need for some test projects to be­gin in­te­grat­ing physi­cian and ad­min­is­tra­tive teams. That could even be some­thing as sim­ple as a com­mit­tee work­ing on safety.

MH: Let’s talk a lit­tle bit about burnout. What are you see­ing among your mem­bers and physi­cian com­mu­nity, in gen­eral? What’s be­ing done to ad­dress this?

An­good: Morale in the health­care work­force is a big is­sue, and it is not just the physi­cians, it’s nurses, it’s other an­cil­lary health­care providers. It’s a re­flec­tion on the com­plex­ity of the in­dus­try. And good peo­ple with high lev­els of ide­al­ism or al­tru­ism are get­ting frus­trated by the in­creas­ing com­plex­ity. So it’s a real thing.

What we are see­ing so far is more of a re­ac­tion by the in­dus­try to help in­di­vid­u­als with their cop­ing skills and their cop­ing mech­a­nisms to im­prove their mind­ful­ness. As an or­ga­ni­za­tion, we feel that’s cer­tainly an im­por­tant piece of this, but we are tak­ing ap­proaches that are a bit more holis­tic in terms of help­ing the in­di­vid­ual, as a human, get bet­ter and have bet­ter con­text for them­selves as a pro­fes­sional. Then, how do we help them with de­vel­op­ing a set of solutions and com­mit­ments to help­ing their or­ga­ni­za­tion, help­ing the health­care in­dus­try, in a broader sense, im­prove it­self?

When you don’t un­der­stand or don’t have the con­text, then you get frus­trated and you get grumpy and you get de­mor­al­ized.

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