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. |
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August 4, 2020 Strategic Questions for Physicians Part 2 Specialist physicians also face strategic choices and no matte which is made, the future will bring major changes. July 20, 2020 Strategic Questions for Physicians Part 1 Several trends are making it imperative for physicians to re-examine their idea of what effective practice of medicine entails. July 6, 2020 Answering Strategic Questions Part 2 What happens if hospitals think of themselves as cost centers, not revenue centers? June 22, 2020 Answering Strategic Questions Answering strategic questions is hard work and also uncertain, but these are not reasons to avoid asking them. June 7, 2020 Uncertainty “It is time…to realize that changes in culture, investment, leadership, and even the distribution of power are more important for progress toward the Triple Aim than measurement, alone, ever was or ever will be.” May 26, 2020 Risk As Michael Tackett put it, we are experiencing a historic referendum on risk. How should we think about it? May 12, 2020 Concordat The pandemic is a time of disruption. Can it be chance to "push the reset button? April 29, 2020 History Lessons If the public response to an epidemic is a play in three parts, we are currently in Act 2 and Act 3. April 13, 2020 Spending Wisely Are we spending our health care dollars wisely? March 30, 2020 Crisis To paraphrase Donald Rumsfeld, you fight coronavirus with the healthcare system you have, not the one you might wish you had. March 10, 2020 Rushing to a Solution? Does our rush to solve organizational problems make them worse? February 26, 2020 Care Management Transitional care management seems likely to be good for patients, but costly to hospital-based organizations. A recent study illuminates the challenge. February 5, 2020 Asking the Right Questions Solutions for problems in health care abound, but are we asking the right questions? January 21, 2020 "Hotspotting" "Hotspotting" is a new term for an old idea, but it usually means identifying and intervening on patients who are, or at risk for becoming, superutilizers. But are we asking the right questions? January 7, 2020 System Failure Medicine has adopted the language of manufacturing with terms such as efficiency, reliability, and “lean processes.” An unintended consequence may be increased risk of system failure. December 16, 2019 The Doctor-Patient Relationship The doctor-patient relationship is central, but is threatened by excessive focus on productivity. But is the productivity-driven payment system corrupt? December 3, 2019 Virtual Integration Platforming is a new buzzword for an old idea--successful organizations put the customer at the center of the business. What does that mean for healthcare organizations? November 18, 2019 Getting the Tempo Right Effective doctor and patient communication requires getting the tempo of the conversation right, not speed, but the current production system makes this a rare event. November 5, 2019 Experimentation Experimentation may seem risky, but is essential for progress. How do we do it safely in challenging times? October 23, 2019 More on the Quality Paradox The quality paradox is the number may improve while the experience of care worsens. What's new? October 8, 2019 Playing it Safe? Many health care organizations have become frightened—so much change is being forced upon them it seems insane to voluntarily try something different. But what it it is essential? September 18, 2019 The Work-Around A work-around get past a problem with addressing either the root cause or a solution. Health care abounds with work-arounds. September 3, 2019 More on Money in Healthcare Hospitals account for the largest fraction of the healthcare dollar, but are usually hegemonic if not monopolies in their communities. Can Trustees call them back to their mission of patient care? August 12, 2019 Getting to Why Reduced government spending by definition means someone's income goes down. To mitigate those changes medical organizations need to get to "why." July 30, 2019 Changing Nature of Work Recent news articles raise issues about the changing nature of work with implications for medical organizations July 9, 2019 Measurement Error Measurement error is recognized in the laboratory, but not in US healthcare, which is causing problems. June 25, 2019 Fluid Intelligence Versus Crystallized Intelligence Minimal staffing using employees with high "fluid intelligence" is a trend not yet proven to be effective. Maybe a better mental model is a combination of fluid and crystallized intelligence, not an "either-or" proposition. June 15, 2019 Meaning or Money The question: is health care about money first or mission first? May 28, 2019 Conflicting Economic Models Providers are being forced to take on financial risk for the cost of care as shown by recent news articles. May 13, 2019 Capitalism in Medicine Is capitalism, with its emphasis on markets, really the appropriate model for health care? April 28, 2019 Costs and Wasteful Care Thinking about aggregate cost won't help doctors reduce unnecessary testing, but understanding Bayesian analysis might. April 9, 2019 Simple Ideas Making simple ideas work turns out to be complicated and hard. March 22, 2019 Improving Clinical Quality Under Fire Touro Infirmary has been in the news but not in a good way. What should it do? March 9, 2019 Beyond Toxic Organizations Are medical organizations toxic environments or is the problem one of changing generational expectations? February 27, 2019 Toxic Institutions Healthcare institutions have unintentionally become toxic places to work. What can be done to address this? February 12, 2019 Beyond Evidence-Based Medicine The problem with EBM is that we are trying to use the method where it does not really apply. January 31, 2019 Big Medicine Big medicine may be financially necessary, but it poses risks unless care is taken to become a real system, which requires putting the clinical enterprise at the center. January 13, 2019 Attribution Attribution is a buzz word for deciding which individual provider is accountable for the cost of a patient's care. On paper the definition seems straight-forward, but in practice it is not really possible to define it. January 2, 2019 Medical Waste Everyone is opposed to wasteful medical spending, but we still don't have a robust definition of what is waste. December 11, 2018 Alignment Alignment is another buzzword that means different things to different people. November 25, 2018 A Season for Everything Maybe it is time to rediscover the art of medicine. November 13, 2018 Stupid Stuff Wouldn't it be wonderful if we got rid of stupid stuff? October 31, 2018 Buzz Words 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 Heroes 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 Making Leaders 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 Actionable Data 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. |