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Here is a list of critical concepts physician leaders must master-and instill in others-in order to thrive.
Health systems and hospitals across the U.S. are in a period of radical reform. With increased patient volumes, changing models of care, workforce shortages and disruptive innovators, healthcare organizations are being challenged to not only adapt, but to transform.
Physician leaders are well-positioned to lead their organizations through the new landscape of care delivery. They have the unique opportunity to develop a management system and culture that puts the patient first, values and engages frontline caregivers, pursues defect-free care, rapidly self-corrects without inflicting blame, and is capable of quickly and effectively adapting to innovative approaches to care. This is, however, much easier said than done.
Borrowing from a few tried and true business management principles that address specific healthcare industry challenges, I’ve compiled a list of critical concepts physician leaders must master-and instill in others-in order to thrive.
1. The ability to adopt a customer first approach
For providers, one of the greatest changes due to the Affordable Care Act has been the influx of new patients. According to the U.S. Department of Health & Human Services, an estimated 20 million people gained health insurance coverage between the passage of the law in 2010 and early 2016.
With increased patient volume comes stress on the system and physician leaders. To effectively manage this influx of new patients, physician leaders need to design systems of care that prioritize the patient while keeping workloads reasonable for physicians and support staff.
The patient is the most important person in any provider organization, because without patients the provider organization would have no reason to exist. Every interaction between a caregiver-defined as anyone who talks to, escorts, comforts, or treats a patient-and a patient, has the potential to be a healing interaction. Any and all caregiver-patient contact can offer a chance to relieve some anxiety, provide comfort, reduce pain, treat an illness, repair an injury, or educate a person on how to live a healthier life. This is the most important thing that we do.
Learning to see through the eyes of the patient is key to ensuring great patient care experiences. This means following the patient as they move from department to department-checking in at registration, seeing the physicians, getting diagnostic tests done, and undergoing treatments.
Focusing only on one department can ensure great care in that location, but without understanding what it is like to navigate the continuum of care, we can easily miss the challenges our patients face in getting their care.
2. The ability to prevent physician burnout by making staff the second priority
While the front-line caregivers must make the patient their priority, the job of the supervisors, managers, directors, and executives is to ensure that the front line caregivers have everything they need to provide great patient care as effectively as possible. In other words, for caregivers the patient must be the priority. For those in management, the front line caregivers and their needs must be the priority.
Physicians are struggling under increasing demands to manage higher volumes of patients who present with more complex clinical conditions and cultural/linguistic backgrounds. This increased demand is colliding with changes in the workplace-a growing number of performance metrics, increased documentation requirements, and lowering reimbursements.
Highly trained and experienced professionals are being put into situations in which they continuously run into barriers and frustrations that make it increasingly difficult to work effectively.
This mismatch between the worker and the workplace leads to burnout. According to “The Truth About Burnout,” those mismatches include: work overload, lack of control, insufficient rewards, breakdown of community, absence of fairness, and conflict of values. Physicians increasingly experience the additional stressors of time pressure and chaotic work environments.
Physician burnout impedes an organization’s ability to deliver safe and effective care, and puts physicians at risk of serious problems including exhaustion, cynicism, and a feeling of ineffectiveness, all of which increase the risk for physicians of depression and suicide.
3. The ability to foster a collaborative environment that values business and physician alignment
Many healthcare organizations respond to burnout by developing physician wellness programs. These programs are invaluable to support physicians and help them cope. They do not address the root cause of burnout. Asking physicians to become more resilient risks making their lack of resilience the problem.
When over 50% of physicians are experiencing burnout, the problem is not the physician’s inadequacy. It is the toxicity of the workplace. Fortunately, there are organizations embracing new approaches to management that counter workplace toxicity and reduce the risk of burnout.
Lean management, done right, is such an approach. It is deeply rooted in the Lean principles of respect for people and continuous improvement. These principles guide the organizations leaders in all they do.
Leaders show physicians respect by:
The leaders that hunker down in the C-suite to develop novel strategies for change are destined for failure. They must acknowledge that all of their employees have a lot to offer about how to improve processes and operations.
4. The ability to shift from autonomy to alignment
Physician autonomy is the norm in healthcare. For physicians that “grew up” in the profession over the last 30 or so years, making patient care decisions independent of the rest of the organization and staying on the sidelines during strategic systemwide decision making is just what you do-and up until recently it worked.
Operationally, this self-governing, siloed and incommunicative business model is proving detrimental to patients and hospitals alike. On the physician front, shifting from traditional autonomy to working in a team can be a challenge. Physicians are used to making their own decisions and are traditionally not trained to work in a team-based environment.
Lean provides a mechanism to move from autonomy to alignment. The Lean process of strategy deployment identifies the organization’s aspirational goals, the “True North” that will take years to realize. It then determines what needs to be done in the next year to move toward the goals, defines the tactics to pursue, the metrics that will demonstrate success, and the people who are responsible to support the work.
True North metrics focus on quality, safety, patient experience, staff and physician engagement, and financial stewardship-all of which are required to succeed as healthcare focuses on the pursuit of the Triple Aim.
By aligning the front line work with the True North metrics physicians can see how they contribute to the organization’s success, and the benefit of their patients and themselves.
5. The ability to embrace disruptive innovators and adapt to change
No successful enterprise-think Apple or Google-sustains its business by offering the same products and services year-after-year unchanged. Instead, they continuously focus on what’s next and ways to make improve the process and customer experience. The same is true in healthcare.
As the healthcare industry continues to face increasing pressure to improve the quality of care and value production, the proliferation of new healthcare technology is exploding. Significant disruptive innovators such as new sensor technology, cloud-based data storage, computational biology and big data are changing the way care is delivered, assessed, and paid for.
To be effective for any period of time, a healthcare leader needs to create an adaptable environment that values continuous improvement, and doesn’t flinch at the notion of change. The Lean management model hardwires that adaptability. The ability to rapidly adapt to a changing environment is a critically important strategic advantage in this era of rapid and unpredictable change.
Paul DeChant, MD, MBA, is senior advisor, Simpler Healthcare, and former CEO, Sutter Gould Medical Foundation.