Clinical Leadership for Practicing Physicians
Medical organizations have never needed leadership from their physicians more than they do today. I started my consulting service to help physicians and their organizations provide this leadership, since excellent patient care depends upon it. Why is there a problem? There are two related problems. First, many medical organizations don’t think they need their front-line clinicians involved in “the business.” Second, many physicians don’t know how to be helpful even if they do have opportunities to be involved.
I think the best mental model for a healthcare organization of any size is triangular with three boundary conditions for failure: clinical, financial, and human. The successful organization will find a way to maintain a dynamic balance of forces that keeps the organization functioning in all three domains with sufficient resilience to overcome the inevitable jolts. Physicians must be involved in defining clinical success and failure and must be involved in leading their particular clinical microsystem.
Physicians are the only ones, for instance, who can decide when a patient should be “off protocol.” They are the ones who must decide when standard care should be provided and when personalized, non-standard, care is appropriate. They are also in a good place to measure stress in the clinical support staff if workload exceeds capacity or training is not sufficient. After all, few of us practice without help from a virtual army of nurses and technicians. Yet few physicians receive any training in these issues during medical school and residency and there are fewer opportunities for on-the-job training with effective mentors.
I have also spent many years leading courses and seminars designed to teach the basics of leadership to physicians and have incorporated many of the things I have learned from doing so in these articles. But leadership is not a skill obtained in a vacuum—it always occurs in a specific organizational context. Consequently, I have also tried to distill insights into the increasingly bureaucratic large organizations within which physicians now practice to help guide their education.
Finally, no organization exists in a vacuum. Trends in medical practice, changes in the way health care is financed and organized impact everyone, so physicians must stay abreast of these changes. I contend the central challenge in the practice of medicine today is keeping an eye on the patient’s needs. It may seem obvious, but the competing priorities of different organizations and the influence of money makes it very hard to keep patients at the center of any organization. Frontline clinicians must do so if organizations are to succeed.
Some organizations recognize their issues, but it can be helpful to bring in an outsider to say the things that need to be said. After all, the consultant goes home and does not have to live in the daily politics of the organization. If that is your situation, I am available for talks, seminars, and individual coaching for physicians attempting to provide clinical leadership in their organizations. Contact me and we can discuss your needs.
Other organizations are not sure of their issues, so it can be helpful to bring in an outsider to establish a “diagnosis” and recommend various treatment options. Just like in clinical medicine, though, it is up to the patient to accept the diagnosis and follow through on the treatment plan. If this is your situation, contact me and we can discuss your needs.
Even if you don’t need a consultation, I hope you find the articles on this website informative, provocative and helpful as you think about how you can help your organization provide high-quality medical care in today’s complicated environment. You can sign up for email notification when new articles are posted or follow me on LinkedIn or Facebook and receive notification that way. It is only together that we can improve the care of our patients, so learning how to work together in our organizations is truly a matter of life or death.
November 25, 2018
A Season for Everything
Maybe it is time to rediscover the art of medicine.
November 13, 2018
Wouldn't it be wonderful if we got rid of stupid stuff?
October 31, 2018
Buzz words are verbal shorthand phrases that often conceal complex underlying realities.
October 15, 2018
The Primary Care Dilemma
When people are well they want convenient care, but when they are sick they want "the best." Is that possible?
October 1, 2018
Is the heroic age of medicine over? If not, what would heroism look like?
September 17, 2018
The 1% Solution
Efforts to constrain health care costs have not been very effective. Maybe instead of grand solutions we need a series of "1% solutions."
September 5, 2018
Is leadership nature or nurture? Probably both.
August 20, 2018
Coaching and Process Improvement
Can individual coaching be a key to process improvement?
August 6, 2018
Barriers to Innovation
Innovation is critical for organizational survival, but internal and external forces make it difficult.
July 26, 2018
Medical organizations have a lot of data, much of which is not "actionable." However, if taken as a vital sign, such data can lead to important actions that indirectly improve "the numbers."
July 12, 2018
Unit Culture and the Leader
Creating and maintaining a positive, patient-oriented culture that supports doing the right thing the right way is the central task of medical leadership today.
June 25, 2018
Physician Decision Making
Physician decision-making is both complex and deals with uncertainty dooming current simple approaches to changing physician behavior.
June 11, 2018
Money and Medicine Part 2
Many physicians and hospitals have entered into employment relationships, but neither are happy with the result.
May 29, 2018
Money in Medicine
Money has always been part of medicine, but it seems both quantitatively and qualitatively different now.
May 14, 2018
An expert panel has concluded less than half of current measures used by CMS to assess value for primary care services are valid. What does this tell us about current pay-for-performance efforts?
April 30, 2018
New Ideas About Electronic Health Records
The data entry burdens of electronic health records contribute to physician burnout and may harm patients. Two recent articles give hope that people are beginning to search for ways to turn EHR's into aids for patient care instead.
April 17, 2018
Team Building V
Successful medical organizations are intentional about developing and maintaining robust small unit leadership.
April 10, 2018
Team Building IV
Since people aren't like Mr. Spock, team building must consider emotional factors to be successful.
April 3, 2018
Team Building III
Addressing why teams are formed requires considering mental models, transactive memory, and team learning.
March 20, 2018
Team Building II
Team building is hard work--getting the right people and bringing them in right are important processes.
March 7, 2018
Building good teams is hard work. What does it take to be successful?
February 21, 2018
Why Physicians Don't Lead
Why don't physicians lead? Maybe a better question is how do you create opportunities for constructive leadership?
February 7, 2018
Care Redesign is one step needed to deal with clinician burnout.
January 24, 2018
Physician Leadership That Leads to Success
Some organizations deem physician leadership essential, others don't. Why?
January 11, 2018
Waste and the Cost of Care
There is no doubt individual health care expenditures have grown faster than the economy. Is this due to increased intensity of service (waste)?
December 27, 2017
Equipoise can be defined as a state of equilibrium or counterbalance. We would do well to seek it both personally and as institutions.
December 11, 2017
What really matters to practicing physicians?
November 27, 2017
A new study suggests only 5% of Medicare spending in 2012 was preventable, much of it in frail, elderly patients. Is this good news or bad?
November 9, 2017
Dunbar's research suggests a practical limit to our human capacity for emotional connection with others. This has important implications for dialysis unit function.
October 25, 2017
Regret is a universal emotion. Although we try, avoiding regret is not possible, and our desire to do so creates costs to everyone.
October 12, 2017
Perspectives on Physician Leadership
Physician leadership is receiving more attention. Three recent articles illuminate the need for and the challenges to physicians leading.
September 26, 2017
If asked about the greatest advances I have seen, my outside the box answer would be the insight that the quality and safety of medical care is as much about system design as it is about human performance. Current efforts to make providers financially accountable, though, threaten the utility of this insight.
September 13, 2017
What Makes a Successful Physician?
What skills are required to be a successful practicing physician?
August 28, 2017
Messaging is replacing dialogue in clinical practice to the detriment of all.
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.