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.
March 30, 2020
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
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" 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
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
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 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
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 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
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
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 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 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
Everyone is opposed to wasteful medical spending, but we still don't have a robust definition of what is waste.
December 11, 2018
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
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.