Physician leadership is essential if medical organizations are to survive and prosper in the current environment, but many physicians do not understand why or how they should do this while engaged in active practice. If we see that our interactions with those who help us take care of our patients constitutes a clinical microsystem, where our impact is critical, and we learn to shape our behaviors to improve the microsystem, we will improve the care of our patients by building stable teams who can improve their practices over time.
Being an effective clinical leader does not require a formal degree in business or management, but it does require some reflection about the nature of medical practice, the nature of medical organizations, and the pressures of health care reform. It also requires some reflection about the differences between formal and informal leadership, and between clinical and managerial leadership. Others are also addressing aspects of the problem of physician leadership, and you can find more detail there.
The articles are written by a practicing physician for practicing physicians. While each article is meant to stand alone, there are several themes. First, I believe evidence based medicine is distorting patient-centered care in ways that were not intended, just as the goals of creating value, as opposed to volume and introduction of electronic health records, is creating unintended distortions. I am a proponent of continuous quality improvement methods as a technique, but inappropriate application can cause damage that mitigates the gains. We should strive to standardize that which should be standardized, but no more. We also need to appreciate that the signals obtained about clinical practice are inherently fuzzy. Big data will not improve the certainty with which we can know the appropriate course of action in all patients at all times. The "quality paradox" is that the more we try to account for healthcare, the more we risk diverting our attention away from the things that matter to our patients and ourselves as clinicians.
Medicine is big business and a major cost to the taxpayer. There is no chance the financial pressures for efficiency will abate. However, what makes sense at the macro level may not make sense at the individual patient level. But we know that much of what we do now is not helping improve outcomes, and we must be prepared to adjust our practice habits to become more effective as well as efficient. We must also learn to admit the limits of our ability to help patients, and I predict we will develop a consensus that therapy of low, but no zero, utility, should not be applied as liberally as they are today.
Physicians have always possessed specialized knowledge and have faced the need to translate that knowledge into information patients can act upon. Today, we face the need to translate our knowledge of clinical realities into information businessmen and policy makers can act upon.
The most recent articles are listed in the panel on the right. Previous articles are grouped in four categories: clinical leadership, team building in medical organizations, medical practice, and challenges posed by healthcare reform. You can use the tabs to find a table of articles related to each topic. With each article I have tried to show links to related articles to allow you to develop your own "curriculum."
I hope you find these articles useful. My goal is to challenge you to think about how you practice medicine today, and how you can make relatively small changes that will improve your practice environment both today and tomorrow. Feedback, including arguments are welcome. I can be reached at firstname.lastname@example.org.
August 14, 2017
Medical Care as a Commodity
Are big data and machine learning likely to solve the problem of uncertainty in medical practice?
July 27, 2017
How do physicians deal with complex, uncertain health care situations? Scenario planning is better than quoting statistics.
July 13, 2017
A recent flurry of articles show the challenges to medical practice have reached critical mass.
June 28, 2017
More Data on the Value Proposition
Value-Based Purchasing" is a complex program designed to improve hospital quality and outcomes by using financial leverage. A recent study by Ryan and associates suggest it has had minimal effect.
June 15, 2017
Human Capital - Physician Burnout
If physicians are important human capital, then burnout is a waste of a valuable resource, but the problem is getting worse, not better.
June 4, 2017
More on Human Capital
Human capital is essential for any organizations, but failure to nurture it spells doom. Yet organizations routinely ignore this. Why?
May 14, 2017
Politics and Medical Organizations
Organizational politics are inevitable, so recognizing the types and the advantages and disadvantages of each is important.
March 28, 2017
Measuring Stress in Your Team
Making health care organizations more successful may begin with recognizing distress in the persons providing the care. But how?
April 17, 2017
Why the Value Proposition is Not Selling
Why is there resistance to the value proposition in health care?
March 30, 2017
Another Look at the Value Proposition
A review of published data show pay for performance programs have not impacted either cost of care or health outcomes.
March 13, 2017
Variation in Health Care
Is variation in health care good, bad, or inevitable? The answer may determine future medical practice.
February 27, 2017
Emotional Intelligence for Physicians
How do physicians rate in the domains of emotional intelligence?
February 15, 2017
On Leadership and the Pygmalion Effect
Does what we believe determine what we get?
January 31, 2017
We are naturally drawn to the dramatic, heroic intervention, but real medical progress is measured in small increments.
January 17, 2017
Is empathy the value we have tossed out as part of "improving" health care?
January 3, 2017
A Data-Driven Argument for Physician Leadership
Dr. J. K. Stoller of the Cleveland Clinic and associates have written an article entitled "Why The Best Hospitals are Managed by Physicians."
December 20, 2016
More on Physician Work
The changing nature of physician work is decreasing the availability, and probably the quality of care at a time when demand is increasing. Two recent articles provide data supporting these effects.
December 1, 2016
It might seem obvious what a physician's work is, but there are conflicting definitions which are causing problems.
November 21, 2016
Dealing with uncertainty is at the core of practicing medicine. Have we tried to escape this reality?
October 30, 2016
Short Term Risk For Long Term Reward
Health care executives are faced with taking major short-term risks to their organization's survival in hopes of long-term benefit. This is new territory for them, but is a common problem for physicians.
October 17, 2016
What Are You Looking For In a Leader?
Picking leaders is critically important to an organization, so what should you look for?
October 8, 2016
Do Employed Physicians Deliver Better Care?